The Safety and Efficacy of Dilation in Eosinophilic Esophagitis
The Safety and Efficacy of Dilation in Eosinophilic Esophagitis
Background Oesophageal dilation is one of the most effective options in the management of symptoms of eosinophilic oesophagitis (EoE). However, earlier reports described an increased rate of complications.
Aim To perform a meta-analysis of population-based studies of the risks associated with dilation and the clinical efficacy and duration of response to dilation in EoE.
Methods Using MEDLINE and EMBASE, a systematic search was performed for published articles since 1977 describing cohort or randomised controlled trials of dilation in EoE. Summary estimates, including 95% confidence interval (CI), were calculated for the occurrence of complications associated with dilations (perforations, haemorrhage, chest pain, lacerations) and percentage of patients with symptom improvement following dilation. Heterogeneity was calculated using the I statistic.
Results The search resulted in 232 references, of which 9 studies were included in the final analysis. The studies described 860 EoE patients, of whom 525 patients underwent at least one oesophageal dilation and a total of 992 dilations. There were three cases of perforation (95% CI 0–0.9%, I 0%) and one haemorrhage (95% CI 0–0.8%, I 0%). Six studies reported postprocedural chest pain in 2% of cases (95% CI 1–3, I 53%). Clinical improvement from dilation occurred in 75% of patients (95% CI 58–93%, I 86%).
Conclusions Dilation in patients with eosinophilic oesophagitis is a safe procedure with a low rate of serious complications (<1%), and seems to result in at least a short-term improvement of symptoms in the majority of patients.
Eosinophilic oesophagitis (EoE) is a chronic inflammatory immune-mediated condition characterised by symptoms of oesophageal dysfunction and marked eosinophilic infiltration of the oesophageal mucosa. Dysphagia and recurrent food impactions are the predominant symptoms seen in adults. For many EoE patients, these symptoms may significantly affect their quality of life. Several treatment options exist; however, symptom relapse remains high. Oesophageal dilation is one of the most effective therapies for symptomatic relief of EoE, even though it does not alter the underlying disease process. Earlier reports on performing dilation in patients with EoE described a higher than expected rate of complications, which included perforation, bleeding, postprocedural discomfort and hospitalisation, making this a less attractive approach in management. More recent studies, however, have shown dilation to be an otherwise safe procedure. The aim of this study was to perform a systematic review of the literature and meta-analysis of the risks associated with oesophageal dilation in adult patients with biopsy-proven EoE, as well as the clinical efficacy and duration of response to dilation in these patients.
Abstract and Introduction
Abstract
Background Oesophageal dilation is one of the most effective options in the management of symptoms of eosinophilic oesophagitis (EoE). However, earlier reports described an increased rate of complications.
Aim To perform a meta-analysis of population-based studies of the risks associated with dilation and the clinical efficacy and duration of response to dilation in EoE.
Methods Using MEDLINE and EMBASE, a systematic search was performed for published articles since 1977 describing cohort or randomised controlled trials of dilation in EoE. Summary estimates, including 95% confidence interval (CI), were calculated for the occurrence of complications associated with dilations (perforations, haemorrhage, chest pain, lacerations) and percentage of patients with symptom improvement following dilation. Heterogeneity was calculated using the I statistic.
Results The search resulted in 232 references, of which 9 studies were included in the final analysis. The studies described 860 EoE patients, of whom 525 patients underwent at least one oesophageal dilation and a total of 992 dilations. There were three cases of perforation (95% CI 0–0.9%, I 0%) and one haemorrhage (95% CI 0–0.8%, I 0%). Six studies reported postprocedural chest pain in 2% of cases (95% CI 1–3, I 53%). Clinical improvement from dilation occurred in 75% of patients (95% CI 58–93%, I 86%).
Conclusions Dilation in patients with eosinophilic oesophagitis is a safe procedure with a low rate of serious complications (<1%), and seems to result in at least a short-term improvement of symptoms in the majority of patients.
Introduction
Eosinophilic oesophagitis (EoE) is a chronic inflammatory immune-mediated condition characterised by symptoms of oesophageal dysfunction and marked eosinophilic infiltration of the oesophageal mucosa. Dysphagia and recurrent food impactions are the predominant symptoms seen in adults. For many EoE patients, these symptoms may significantly affect their quality of life. Several treatment options exist; however, symptom relapse remains high. Oesophageal dilation is one of the most effective therapies for symptomatic relief of EoE, even though it does not alter the underlying disease process. Earlier reports on performing dilation in patients with EoE described a higher than expected rate of complications, which included perforation, bleeding, postprocedural discomfort and hospitalisation, making this a less attractive approach in management. More recent studies, however, have shown dilation to be an otherwise safe procedure. The aim of this study was to perform a systematic review of the literature and meta-analysis of the risks associated with oesophageal dilation in adult patients with biopsy-proven EoE, as well as the clinical efficacy and duration of response to dilation in these patients.
