Esophageal dilation in eosinophilic esophagitis: risks, benefits, and when to do it

Current Opinion in Gastroenterology
Alfredo J Lucendo, Javier Molina-Infante

Abstract

For patients with eosinophilic esophagitis (EoE), endoscopic dilation has been used primarily to provide immediate symptomatic relief of dysphagia. This report reviews the current position of esophageal dilation in the therapeutic algorithm for EoE, including effectiveness and safety issues. Esophageal strictures in EoE develop as a consequence of long-lasting esophageal eosinophilia, with patient age and diagnostic delay as well established risk factors. Endoscopic dilation leads to immediate symptomatic improvement in 95% of EoE patients who have strictures or narrow caliber esophagus. As dilation has no effect on the underlying eosinophil inflammation, repeated procedures are usually needed to maintain symptoms in remission. Adding an effective drug or dietary-based EoE therapy reduces the need of further dilation. The high rate of severe complications from dilation reported in early literature has not been reproduced in most recent series, with mild postprocedural chest pain as the most common side effect. Current data suggest that the risk of esophageal perforation is less than 1%. Mucosal tears after dilation should no longer be considered a complication, but rather a marker of procedural success. Esophageal dilation shou...Continue Reading

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Citations

Feb 2, 2019·Current Treatment Options in Gastroenterology·Quan M Nhu, Fouad J Moawad
Dec 18, 2019·Expert Review of Clinical Immunology·Alfredo J Lucendo
Mar 14, 2020·Digestive Diseases and Sciences·Daniel A SchupackJeffrey A Alexander
Oct 8, 2020·World Journal of Gastroenterology : WJG·Simon Nennstiel, Christoph Schlag
Feb 23, 2021·Therapeutic Advances in Gastroenterology·Pierfrancesco VisaggiNicola de Bortoli
Jan 25, 2022·Expert Opinion on Investigational Drugs·Sonsoles Tamarit-SebastianAlfredo J Lucendo

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Methods Mentioned

BETA
biopsy
sedation

Software Mentioned

EndoFLIP

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