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Evan S. Dellon - One of the best experts on this subject based on the ideXlab platform.
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Obesity reduces the requirement for subsequent esophageal stricture Dilation in adults with eosinophilic esophagitis
Esophagus, 2021Co-Authors: David Miller, Evan S. Dellon, Sheena Mago, John W. Birk, Paul J. Feustel, Micheal TadrosAbstract:Background Eosinophilic esophagitis (EoE) causes esophageal narrowing and strictures, but factors that modify the severity of strictures and requirement for subsequent Dilation are not well described. The aim of this study was to identify characteristics that impact the need for repeat (> 1) esophageal Dilations in EoE patients. Methods This was a single center retrospective cohort study over a 12-year period (September 2005–October 2017). Patients were identified using ICD9, ICD10, and CPT codes for esophageal Dilation, eosinophilic esophagitis, and esophageal obstruction. Data for EoE clinical characteristics, treatments, and BMI were extracted and correlated to the number of esophageal Dilations and time elapsed between Dilations. Results Of the 21 patients who met inclusion criteria, 11 (52%) had at least two Dilations and 9 (43%) had three Dilations. There was no differences baseline demographics between patients who needed ≥ 2 vs. those who needed one Dilation. However, patients with a BMI > 30 had a significantly longer median time to second Dilation compared to non-obese patients (4.9 years vs. 1.8 years; p = 0.027). Stratification by either high dose PPI or inhaled steroid use did not change this result. Conclusions EoE patients with strictures who are obese have a reduced requirement for subsequent esophageal Dilation. While the mechanism for this is not clear, increased attention of non-obese patients with fibrostenotic EoE is indicated as they are at higher risk for recurrent strictures.
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esophageal Dilation with either bougie or balloon technique as a treatment for eosinophilic esophagitis a systematic review and meta analysis
Gastrointestinal Endoscopy, 2017Co-Authors: Michael Dougherty, Thomas M. Runge, Swathi Eluri, Evan S. DellonAbstract:Background and Aims Esophageal Dilation is a now recognized to be an important therapeutic modality in eosinophilic esophagitis (EoE). We aimed to evaluate the safety of esophageal Dilation in EoE, especially regarding perforation risk, and to examine perforation risk by dilator type. Methods We conducted a systematic review of the published literature from January 1, 1950 to June 30, 2016 using PubMed, EMBASE, and Web of Science. Studies were included if they described patients with EoE who underwent elective esophageal Dilation and also reported the presence or absence of at least 1 adverse event (eg, perforation, bleeding, pain, or hospitalization). We used random-effects meta-analysis to estimate the frequency of each adverse event. Results Of 923 identified articles, 37 met inclusion criteria and represented 2034 Dilations in 977 patients. On meta-analysis, postprocedure hospitalization occurred in .689% of Dilations (95% confidence interval [CI], 0%-1.42%), clinically significant GI hemorrhage in .028% (95% CI, 0%-.217%), and clinically significant chest pain in 3.64% (95% CI, 1.73%-5.55%). Nine perforations were documented, at a rate of .033% (95% CI, 0%-.226%) per procedure after meta-analysis. None of the perforations resulted in surgical intervention or mortality. Most (5/9) were reported before 2009 (rate, .41% [95% CI, 0%-2.75%]); from 2009 forward the rate was .030% (95% CI, 0%-.225%). Dilation method was described in 30 studies (1957 Dilations), in which 4 perforations were detected. The estimated perforation rate for bougies was .022% (95% CI, 0%-.347%) and for balloons was .059% (95% CI, 0%-.374%). Conclusions Perforation from esophageal Dilation in EoE is rare, and there is no evidence of a significant difference in perforation risk related to dilator type. Esophageal Dilation should be considered a safe procedure in EoE.
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Control of inflammation decreases the need for subsequent esophageal Dilation in patients with eosinophilic esophagitis.
Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus, 2017Co-Authors: Thomas Runge, Swathi Eluri, John T. Woosley, Nicholas J. Shaheen, Evan S. DellonAbstract:It is unknown if successful control of esophageal inflammation in eosinophilic esophagitis (EoE) decreases the need for subsequent esophageal Dilation. We aimed to determine whether histologic response to topical steroid treatment decreases the likelihood and frequency of subsequent esophageal Dilation. We conducted a retrospective cohort study. Patients with an incident diagnosis of EoE were included if they had an initial esophageal Dilation, received topical steroids, and had a subsequent endoscopy with biopsies. The number of Dilations performed in each group was determined, and histologic responders (
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Esophageal Dilation with either bougie or balloon technique as a treatment for eosinophilic esophagitis: a systematic review and meta-analysis
Gastrointestinal endoscopy, 2017Co-Authors: Michael Dougherty, Thomas M. Runge, Swathi Eluri, Evan S. DellonAbstract:Esophageal Dilation is a now recognized to be an important therapeutic modality in eosinophilic esophagitis (EoE). We aimed to evaluate the safety of esophageal Dilation in EoE, especially regarding perforation risk, and to examine perforation risk by dilator type. We conducted a systematic review of the published literature from January 1, 1950 to June 30, 2016 using PubMed, EMBASE, and Web of Science. Studies were included if they described patients with EoE who underwent elective esophageal Dilation and also reported the presence or absence of at least 1 adverse event (eg, perforation, bleeding, pain, or hospitalization). We used random-effects meta-analysis to estimate the frequency of each adverse event. Of 923 identified articles, 37 met inclusion criteria and represented 2034 Dilations in 977 patients. On meta-analysis, postprocedure hospitalization occurred in .689% of Dilations (95% confidence interval [CI], 0%-1.42%), clinically significant GI hemorrhage in .028% (95% CI, 0%-.217%), and clinically significant chest pain in 3.64% (95% CI, 1.73%-5.55%). Nine perforations were documented, at a rate of .033% (95% CI, 0%-.226%) per procedure after meta-analysis. None of the perforations resulted in surgical intervention or mortality. Most (5/9) were reported before 2009 (rate, .41% [95% CI, 0%-2.75%]); from 2009 forward the rate was .030% (95% CI, 0%-.225%). Dilation method was described in 30 studies (1957 Dilations), in which 4 perforations were detected. The estimated perforation rate for bougies was .022% (95% CI, 0%-.347%) and for balloons was .059% (95% CI, 0%-.374%). Perforation from esophageal Dilation in EoE is rare, and there is no evidence of a significant difference in perforation risk related to dilator type. Esophageal Dilation should be considered a safe procedure in EoE. Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
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Outcomes of Esophageal Dilation in Eosinophilic Esophagitis: Safety, Efficacy, and Persistence of the Fibrostenotic Phenotype
The American journal of gastroenterology, 2016Co-Authors: Thomas M. Runge, Swathi Eluri, Cary C. Cotton, Caitlin M. Burk, John T. Woosley, Nicholas J. Shaheen, Evan S. DellonAbstract:Esophageal Dilation is commonly performed in eosinophilic esophagitis (EoE), but there are few long-term data. The aims of this study were to assess the safety and long-term efficacy of esophageal Dilation in a large cohort of EoE cases, and to determine the frequency and predictors of requiring multiple Dilations. We conducted a retrospective cohort study in the University of North Carolina EoE Clinicopathological Database from 2002 to 2014. Included subjects met consensus diagnostic criteria for EoE. Clinical, endoscopic, and histologic features were extracted, as were Dilation characteristics (dilator type, change in esophageal caliber, and total number of Dilations) and complications. Patients with EoE who had undergone Dilation were compared with those who did not and also stratified by whether they required single or multiple Dilations. Of 509 EoE patients, 164 were dilated a total of 486 times. Those who underwent Dilation had a longer duration of symptoms before diagnosis (11.1 vs. 5.4 years, P<0.001). Ninety-five patients (58%) required >1 Dilation (417 Dilations total, mean of 4.4±4.3 per patient). The only predictor of requiring multiple Dilations was a smaller baseline esophageal diameter. Dilation was tolerated well, with no major bleeds, perforations, or deaths. The overall complication rate was 5%, primarily due to post-procedural pain. Of 164 individuals dilated, a majority (58% or 95/164) required a second Dilation. Of these individuals, 75% required repeat Dilation within 1 year. Dilation in EoE is well-tolerated, with a very low risk of serious complications. Patients with long-standing symptoms before diagnosis are likely to require Dilation. More than half of those dilated will require multiple Dilations, often needing a second procedure within 1 year. These findings can be used to counsel patients with fibrostenotic complications of EoE.
Peter C. Belafsky - One of the best experts on this subject based on the ideXlab platform.
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Improved symptomatic, functional, and fluoroscopic outcomes following serial “series of three” double-balloon Dilation for cricopharyngeus muscle dysfunction
Journal of Otolaryngology - Head & Neck Surgery, 2018Co-Authors: Derrick R. Randall, Lisa M. Evangelista, Maggie A. Kuhn, Peter C. BelafskyAbstract:Background Cricopharyngeus muscle dysfunction (CPMD) is a common cause of dysphagia. We employ a progressive series of three double-balloon Dilations separated by 4–6 weeks between procedures as a primary treatment option. The purpose of this study was to evaluate subjective, functional and objective improvement in swallowing after three serial Dilations for CPMD. Methods We retrospectively evaluated patients between June 1, 2014, and June 30, 2016, who underwent a series of three double-balloon Dilations for CPMD. Pre- and post-Dilation Eating Assessment Tool-10 (EAT-10), Functional Oral Intake Scale (FOIS), pharyngeal constriction ratio, pharyngeal area, and pharyngoesophageal segment (PES) opening were compared. Results Seventeen patients with CPMD underwent serial double-balloon Dilation procedures separated by one month. Mean age of the cohort was 73.5 (SD ± 13.3) years, and 53% were female. The mean EAT-10 improved from 24.7 (SD ± 7.8) to 15.9 (SD ± 10.2) [ p = 0.0021]. Mean FOIS improved from 5.4 (SD ± 1.4) pre- to 6.3 (SD ± 0.9) post-treatment ( p = 0.017). Mean UES opening increased from 1.05 (SD ± 0.34) cm to 1.48 (SD ± 0.41) cm ( p = 0.0003) in the anteroposterior fluoroscopic view and from 0.58 (SD ± 0.18) to 0.76 (SD ± 0.30) cm ( p = 0.018) in the lateral view. Pharyngeal constriction ratio (PCR), a surrogate measure of pharyngeal strength, improved from 0.49 (SD ± 0.37) to 0.24 (SD ± 0.15) ( p = 0.015), however pharyngeal area (PA) was unchanged. Conclusions A progressive series of three double-balloon Dilations for cricopharyngeus muscle dysfunction resulted in improved patient reported dysphagia symptom scores and objective fluoroscopic swallowing parameters.
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transnasal balloon Dilation of the esophagus
Archives of Otolaryngology-head & Neck Surgery, 2009Co-Authors: Catherine J Rees, Taylor Fordham, Peter C. BelafskyAbstract:Objective To describe the safety of transnasal balloon Dilation of the esophagus. Design Retrospective case series. Setting Two tertiary care institutions. Patients All patients undergoing transnasal balloon Dilation of the esophagus. Main Outcome Measure Complications. Results Fifty-four transnasal esophageal balloon Dilations were performed in 38 patients. The mean age of the cohort was 65 years (range, 13-88 years). Twenty-nine patients were male (76%). Twenty procedures were performed using only topical anesthesia in the office setting. Seven patients (18%) were postlaryngectomy, and 15 patients (39%) had a history of head and neck radiation therapy. The upper esophageal sphincter (UES) was the most frequent Dilation site (63%), followed by proximal/mid esophagus (26%), lower esophageal sphincter (LES) (7.4%), and both the UES and LES (3.7%). Indications included cricopharyngeal dysfunction, benign stricture, web, and Schatzki ring. Two procedures (3.7%) were aborted secondary to self-limited laryngospasm or gagging. There were no clinically significant complications. Conclusions Transnasal esophageal balloon Dilation can be performed in unsedated or sedated patients with a very low complication rate. The procedure is well tolerated in 96% of patients. This technique, formerly available only through larger caliber oral gastroscopes and under sedation, allows for office-based esophageal balloon Dilation in an otolaryngology practice.
Swathi Eluri - One of the best experts on this subject based on the ideXlab platform.
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esophageal Dilation with either bougie or balloon technique as a treatment for eosinophilic esophagitis a systematic review and meta analysis
Gastrointestinal Endoscopy, 2017Co-Authors: Michael Dougherty, Thomas M. Runge, Swathi Eluri, Evan S. DellonAbstract:Background and Aims Esophageal Dilation is a now recognized to be an important therapeutic modality in eosinophilic esophagitis (EoE). We aimed to evaluate the safety of esophageal Dilation in EoE, especially regarding perforation risk, and to examine perforation risk by dilator type. Methods We conducted a systematic review of the published literature from January 1, 1950 to June 30, 2016 using PubMed, EMBASE, and Web of Science. Studies were included if they described patients with EoE who underwent elective esophageal Dilation and also reported the presence or absence of at least 1 adverse event (eg, perforation, bleeding, pain, or hospitalization). We used random-effects meta-analysis to estimate the frequency of each adverse event. Results Of 923 identified articles, 37 met inclusion criteria and represented 2034 Dilations in 977 patients. On meta-analysis, postprocedure hospitalization occurred in .689% of Dilations (95% confidence interval [CI], 0%-1.42%), clinically significant GI hemorrhage in .028% (95% CI, 0%-.217%), and clinically significant chest pain in 3.64% (95% CI, 1.73%-5.55%). Nine perforations were documented, at a rate of .033% (95% CI, 0%-.226%) per procedure after meta-analysis. None of the perforations resulted in surgical intervention or mortality. Most (5/9) were reported before 2009 (rate, .41% [95% CI, 0%-2.75%]); from 2009 forward the rate was .030% (95% CI, 0%-.225%). Dilation method was described in 30 studies (1957 Dilations), in which 4 perforations were detected. The estimated perforation rate for bougies was .022% (95% CI, 0%-.347%) and for balloons was .059% (95% CI, 0%-.374%). Conclusions Perforation from esophageal Dilation in EoE is rare, and there is no evidence of a significant difference in perforation risk related to dilator type. Esophageal Dilation should be considered a safe procedure in EoE.
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Control of inflammation decreases the need for subsequent esophageal Dilation in patients with eosinophilic esophagitis.
Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus, 2017Co-Authors: Thomas Runge, Swathi Eluri, John T. Woosley, Nicholas J. Shaheen, Evan S. DellonAbstract:It is unknown if successful control of esophageal inflammation in eosinophilic esophagitis (EoE) decreases the need for subsequent esophageal Dilation. We aimed to determine whether histologic response to topical steroid treatment decreases the likelihood and frequency of subsequent esophageal Dilation. We conducted a retrospective cohort study. Patients with an incident diagnosis of EoE were included if they had an initial esophageal Dilation, received topical steroids, and had a subsequent endoscopy with biopsies. The number of Dilations performed in each group was determined, and histologic responders (
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Esophageal Dilation with either bougie or balloon technique as a treatment for eosinophilic esophagitis: a systematic review and meta-analysis
Gastrointestinal endoscopy, 2017Co-Authors: Michael Dougherty, Thomas M. Runge, Swathi Eluri, Evan S. DellonAbstract:Esophageal Dilation is a now recognized to be an important therapeutic modality in eosinophilic esophagitis (EoE). We aimed to evaluate the safety of esophageal Dilation in EoE, especially regarding perforation risk, and to examine perforation risk by dilator type. We conducted a systematic review of the published literature from January 1, 1950 to June 30, 2016 using PubMed, EMBASE, and Web of Science. Studies were included if they described patients with EoE who underwent elective esophageal Dilation and also reported the presence or absence of at least 1 adverse event (eg, perforation, bleeding, pain, or hospitalization). We used random-effects meta-analysis to estimate the frequency of each adverse event. Of 923 identified articles, 37 met inclusion criteria and represented 2034 Dilations in 977 patients. On meta-analysis, postprocedure hospitalization occurred in .689% of Dilations (95% confidence interval [CI], 0%-1.42%), clinically significant GI hemorrhage in .028% (95% CI, 0%-.217%), and clinically significant chest pain in 3.64% (95% CI, 1.73%-5.55%). Nine perforations were documented, at a rate of .033% (95% CI, 0%-.226%) per procedure after meta-analysis. None of the perforations resulted in surgical intervention or mortality. Most (5/9) were reported before 2009 (rate, .41% [95% CI, 0%-2.75%]); from 2009 forward the rate was .030% (95% CI, 0%-.225%). Dilation method was described in 30 studies (1957 Dilations), in which 4 perforations were detected. The estimated perforation rate for bougies was .022% (95% CI, 0%-.347%) and for balloons was .059% (95% CI, 0%-.374%). Perforation from esophageal Dilation in EoE is rare, and there is no evidence of a significant difference in perforation risk related to dilator type. Esophageal Dilation should be considered a safe procedure in EoE. Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
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Outcomes of Esophageal Dilation in Eosinophilic Esophagitis: Safety, Efficacy, and Persistence of the Fibrostenotic Phenotype
The American journal of gastroenterology, 2016Co-Authors: Thomas M. Runge, Swathi Eluri, Cary C. Cotton, Caitlin M. Burk, John T. Woosley, Nicholas J. Shaheen, Evan S. DellonAbstract:Esophageal Dilation is commonly performed in eosinophilic esophagitis (EoE), but there are few long-term data. The aims of this study were to assess the safety and long-term efficacy of esophageal Dilation in a large cohort of EoE cases, and to determine the frequency and predictors of requiring multiple Dilations. We conducted a retrospective cohort study in the University of North Carolina EoE Clinicopathological Database from 2002 to 2014. Included subjects met consensus diagnostic criteria for EoE. Clinical, endoscopic, and histologic features were extracted, as were Dilation characteristics (dilator type, change in esophageal caliber, and total number of Dilations) and complications. Patients with EoE who had undergone Dilation were compared with those who did not and also stratified by whether they required single or multiple Dilations. Of 509 EoE patients, 164 were dilated a total of 486 times. Those who underwent Dilation had a longer duration of symptoms before diagnosis (11.1 vs. 5.4 years, P<0.001). Ninety-five patients (58%) required >1 Dilation (417 Dilations total, mean of 4.4±4.3 per patient). The only predictor of requiring multiple Dilations was a smaller baseline esophageal diameter. Dilation was tolerated well, with no major bleeds, perforations, or deaths. The overall complication rate was 5%, primarily due to post-procedural pain. Of 164 individuals dilated, a majority (58% or 95/164) required a second Dilation. Of these individuals, 75% required repeat Dilation within 1 year. Dilation in EoE is well-tolerated, with a very low risk of serious complications. Patients with long-standing symptoms before diagnosis are likely to require Dilation. More than half of those dilated will require multiple Dilations, often needing a second procedure within 1 year. These findings can be used to counsel patients with fibrostenotic complications of EoE.
Catherine J Rees - One of the best experts on this subject based on the ideXlab platform.
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transnasal balloon Dilation of the esophagus
Archives of Otolaryngology-head & Neck Surgery, 2009Co-Authors: Catherine J Rees, Taylor Fordham, Peter C. BelafskyAbstract:Objective To describe the safety of transnasal balloon Dilation of the esophagus. Design Retrospective case series. Setting Two tertiary care institutions. Patients All patients undergoing transnasal balloon Dilation of the esophagus. Main Outcome Measure Complications. Results Fifty-four transnasal esophageal balloon Dilations were performed in 38 patients. The mean age of the cohort was 65 years (range, 13-88 years). Twenty-nine patients were male (76%). Twenty procedures were performed using only topical anesthesia in the office setting. Seven patients (18%) were postlaryngectomy, and 15 patients (39%) had a history of head and neck radiation therapy. The upper esophageal sphincter (UES) was the most frequent Dilation site (63%), followed by proximal/mid esophagus (26%), lower esophageal sphincter (LES) (7.4%), and both the UES and LES (3.7%). Indications included cricopharyngeal dysfunction, benign stricture, web, and Schatzki ring. Two procedures (3.7%) were aborted secondary to self-limited laryngospasm or gagging. There were no clinically significant complications. Conclusions Transnasal esophageal balloon Dilation can be performed in unsedated or sedated patients with a very low complication rate. The procedure is well tolerated in 96% of patients. This technique, formerly available only through larger caliber oral gastroscopes and under sedation, allows for office-based esophageal balloon Dilation in an otolaryngology practice.
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in office unsedated transnasal balloon Dilation of the esophagus and trachea
Current Opinion in Otolaryngology & Head and Neck Surgery, 2007Co-Authors: Catherine J ReesAbstract:PURPOSE OF REVIEW: Since the advent of ultrathin flexible endoscopes with working channels office-based esophagoscopy and tracheobronchoscopy have been undertaken frequently by otolaryngologists. As a natural extension of these diagnostic procedures, more office-based esophageal and tracheal therapeutic procedures are being undertaken. RECENT FINDINGS: Esophageal and tracheal balloon Dilation can be performed in the unsedated patient using a transnasal approach. These transnasal techniques have not been described in the recent literature. Esophageal balloon Dilation is a well-accepted technique for gastrointestinal endoscopists, and recent literature has focused on indications (such as cricopharyngeal dysfunction) and the development of removable stents for prevention of restenosis. Pulmonary balloon Dilation is likewise well accepted, with recent literature focusing on the timing of intervention and the incidence of tracheobronchial laceration. SUMMARY: Office-based esophageal and tracheal balloon Dilations in unsedated patients are newly described techniques made possible with thin-caliber transnasal endoscopes.
Thomas M. Runge - One of the best experts on this subject based on the ideXlab platform.
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esophageal Dilation with either bougie or balloon technique as a treatment for eosinophilic esophagitis a systematic review and meta analysis
Gastrointestinal Endoscopy, 2017Co-Authors: Michael Dougherty, Thomas M. Runge, Swathi Eluri, Evan S. DellonAbstract:Background and Aims Esophageal Dilation is a now recognized to be an important therapeutic modality in eosinophilic esophagitis (EoE). We aimed to evaluate the safety of esophageal Dilation in EoE, especially regarding perforation risk, and to examine perforation risk by dilator type. Methods We conducted a systematic review of the published literature from January 1, 1950 to June 30, 2016 using PubMed, EMBASE, and Web of Science. Studies were included if they described patients with EoE who underwent elective esophageal Dilation and also reported the presence or absence of at least 1 adverse event (eg, perforation, bleeding, pain, or hospitalization). We used random-effects meta-analysis to estimate the frequency of each adverse event. Results Of 923 identified articles, 37 met inclusion criteria and represented 2034 Dilations in 977 patients. On meta-analysis, postprocedure hospitalization occurred in .689% of Dilations (95% confidence interval [CI], 0%-1.42%), clinically significant GI hemorrhage in .028% (95% CI, 0%-.217%), and clinically significant chest pain in 3.64% (95% CI, 1.73%-5.55%). Nine perforations were documented, at a rate of .033% (95% CI, 0%-.226%) per procedure after meta-analysis. None of the perforations resulted in surgical intervention or mortality. Most (5/9) were reported before 2009 (rate, .41% [95% CI, 0%-2.75%]); from 2009 forward the rate was .030% (95% CI, 0%-.225%). Dilation method was described in 30 studies (1957 Dilations), in which 4 perforations were detected. The estimated perforation rate for bougies was .022% (95% CI, 0%-.347%) and for balloons was .059% (95% CI, 0%-.374%). Conclusions Perforation from esophageal Dilation in EoE is rare, and there is no evidence of a significant difference in perforation risk related to dilator type. Esophageal Dilation should be considered a safe procedure in EoE.
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Esophageal Dilation with either bougie or balloon technique as a treatment for eosinophilic esophagitis: a systematic review and meta-analysis
Gastrointestinal endoscopy, 2017Co-Authors: Michael Dougherty, Thomas M. Runge, Swathi Eluri, Evan S. DellonAbstract:Esophageal Dilation is a now recognized to be an important therapeutic modality in eosinophilic esophagitis (EoE). We aimed to evaluate the safety of esophageal Dilation in EoE, especially regarding perforation risk, and to examine perforation risk by dilator type. We conducted a systematic review of the published literature from January 1, 1950 to June 30, 2016 using PubMed, EMBASE, and Web of Science. Studies were included if they described patients with EoE who underwent elective esophageal Dilation and also reported the presence or absence of at least 1 adverse event (eg, perforation, bleeding, pain, or hospitalization). We used random-effects meta-analysis to estimate the frequency of each adverse event. Of 923 identified articles, 37 met inclusion criteria and represented 2034 Dilations in 977 patients. On meta-analysis, postprocedure hospitalization occurred in .689% of Dilations (95% confidence interval [CI], 0%-1.42%), clinically significant GI hemorrhage in .028% (95% CI, 0%-.217%), and clinically significant chest pain in 3.64% (95% CI, 1.73%-5.55%). Nine perforations were documented, at a rate of .033% (95% CI, 0%-.226%) per procedure after meta-analysis. None of the perforations resulted in surgical intervention or mortality. Most (5/9) were reported before 2009 (rate, .41% [95% CI, 0%-2.75%]); from 2009 forward the rate was .030% (95% CI, 0%-.225%). Dilation method was described in 30 studies (1957 Dilations), in which 4 perforations were detected. The estimated perforation rate for bougies was .022% (95% CI, 0%-.347%) and for balloons was .059% (95% CI, 0%-.374%). Perforation from esophageal Dilation in EoE is rare, and there is no evidence of a significant difference in perforation risk related to dilator type. Esophageal Dilation should be considered a safe procedure in EoE. Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
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Outcomes of Esophageal Dilation in Eosinophilic Esophagitis: Safety, Efficacy, and Persistence of the Fibrostenotic Phenotype
The American journal of gastroenterology, 2016Co-Authors: Thomas M. Runge, Swathi Eluri, Cary C. Cotton, Caitlin M. Burk, John T. Woosley, Nicholas J. Shaheen, Evan S. DellonAbstract:Esophageal Dilation is commonly performed in eosinophilic esophagitis (EoE), but there are few long-term data. The aims of this study were to assess the safety and long-term efficacy of esophageal Dilation in a large cohort of EoE cases, and to determine the frequency and predictors of requiring multiple Dilations. We conducted a retrospective cohort study in the University of North Carolina EoE Clinicopathological Database from 2002 to 2014. Included subjects met consensus diagnostic criteria for EoE. Clinical, endoscopic, and histologic features were extracted, as were Dilation characteristics (dilator type, change in esophageal caliber, and total number of Dilations) and complications. Patients with EoE who had undergone Dilation were compared with those who did not and also stratified by whether they required single or multiple Dilations. Of 509 EoE patients, 164 were dilated a total of 486 times. Those who underwent Dilation had a longer duration of symptoms before diagnosis (11.1 vs. 5.4 years, P<0.001). Ninety-five patients (58%) required >1 Dilation (417 Dilations total, mean of 4.4±4.3 per patient). The only predictor of requiring multiple Dilations was a smaller baseline esophageal diameter. Dilation was tolerated well, with no major bleeds, perforations, or deaths. The overall complication rate was 5%, primarily due to post-procedural pain. Of 164 individuals dilated, a majority (58% or 95/164) required a second Dilation. Of these individuals, 75% required repeat Dilation within 1 year. Dilation in EoE is well-tolerated, with a very low risk of serious complications. Patients with long-standing symptoms before diagnosis are likely to require Dilation. More than half of those dilated will require multiple Dilations, often needing a second procedure within 1 year. These findings can be used to counsel patients with fibrostenotic complications of EoE.
