Retrospective Study
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World J Gastroenterol. Jul 28, 2014; 20(28): 9549-9555
Published online Jul 28, 2014. doi: 10.3748/wjg.v20.i28.9549
Esophageal dilations in eosinophilic esophagitis: A single center experience
Andrew Ukleja, Jennifer Shiroky, Amitesh Agarwal, Daniela Allende
Andrew Ukleja, Jennifer Shiroky, Department of Gastroenterology, Cleveland Clinic Florida, Weston, FL 33331, United States
Daniela Allende, Cleveland Clinic, OH 44195, United States
Amitesh Agarwal, the University of Texas Medical Branch at Galveston, Galveston, TX 77555, United States
Author contributions: Ukleja A and Agarwal A were the treating physicians; Allende D analyzed and assessed the slides; Ukleja A and Shiroky J researched the topic; Shiroky J, Allende D and Agarwal A collected the data; Shiroky J wrote the manuscript; Ukleja A, Shiroky J and Allende D revised and edited the manuscript.
Correspondence to: Andrew Ukleja, MD, AGAF, CNSP, Assistant Professor, Department of Gastroenterology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331, United States. uklejaa@ccf.org
Telephone: +1-954-6595646 Fax: +1-954-6595647
Received: December 30, 2013
Revised: March 1, 2014
Accepted: April 5, 2014
Published online: July 28, 2014
Abstract

AIM: To diagnose the clinical and histologic features that may be associated with or predictive of the need for dilation and dilation related complications; examine the safety of dilation in patients with eosinophilic esophagitis (EoE).

METHODS: The medical records of all patients diagnosed with EoE between January 2002 and July 2010 were retrospectively reviewed. Esophageal biopsies were reexamined by an experienced pathologist to confirm the diagnosis (≥ 15 eos/hpf per current guidelines). Patients were divided into 2 groups: patients who did not receive dilation therapy and those who did. Demographics, clinical history, the use of pharmacologic therapy, endoscopic and pathology findings, and the number of biopsies and dilations carried out, if any, and their locations were recorded for each patient. The dilation group was further examined based on the interval between diagnosis and dilation, and whether or not a complication occurred.

RESULTS: Sixty-one patients were identified with EoE and 22 (36%) of them underwent esophageal dilations for stricture/narrowing. The peak eos/hpf was significantly higher in patients who received a dilation (P = 0.04). Four (18% of pts.) minor complications occurred: deep mucosal tear 1, and small mucosal tears 3. There were no cases of esophageal perforations. Higher peak eos/hpf counts were not associated with increased risk of complications.

CONCLUSION: Esophageal dilation appears to be a safe procedure in EoE patients, carrying a low complication rate. No correlation was found between the peak of eosinophil count and complication rate. Complications can occur independently of the histologic features. The long-term outcome of EoE treatment, with or without dilation, needs to be determined.

Keywords: Balloon dilation, Dysphagia, Esophagus disorder, Esophageal stricture, Esosinophilic esophagitis

Core tip: The field of gastroenterology does not currently have standardized treatment guidelines for eosinophilic esophagitis. Current data on the safety of dilations in patients with eosinophilic esophagitis (EoE) are conflicting and lack information on factors that influence whether or not a patient will require dilation. This study revealed that higher peak eos/hpf counts appear to influence whether or not an EoE patient will require dilation during the course of their treatment. However, complications appear to occur independently of the histologic features. Esophageal dilation appears to be a safe procedure in EoE patients, carrying a low complication rate.