DILATION TREATMENT IN EOSINOPHILIC ESOPHAGITIS

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DILATION TREATMENT IN EOSINOPHILIC ESOPHAGITIS

H Jawa, N Chande
Division of Gastroenterology, Univesity of Western Ontario, London, Ontario
Aims: Esophageal dilation is useful in EE patients with symptomatic narrowing but has been associated with an increased risk for tears and perforations.
OBJECTIVES: Assess the outcomes and rate of complications of dilation treatment in EE patients at the University of Western Ontario. We also aimed to determine whether any baseline characteristics can predict increased risk of complications.
Methods: All patients who were diagnosed with EE by biopsy in London, Ontario between Jan 2004 - Aug 2008 were identified. Charts, endoscopy, and pathology reports of these patients were retrospectively reviewed.
Results: Fifty eight patients had EE. 49 (84.5 %) males and 9 (15.5%) females. Mean age at presentation was 34.5 years. Predominant symptoms were dysphagia (89.7%), food impactions requiring urgent endoscopy (34.5%) and self-limited food impactions (15.5%). One patient was transferred to our centre from a community hospital for surgical esophageal repair for perforation complicating endoscopic attempts to extract an obstructing food bolus. Fourteen (24.1%) patients had asthma and sixteen (25.6%) patients reported allergies. Endoscopic findings included, ringed appearance (56.9%), linear furrows (29.3%), strictures (19%), narrow caliber (13.8%), Schatzki's ring (12.1%), white plaques (8.6%), normal endoscopy (10.3%). Of the 58 EE patients, 51 (87.93%) patients received 79 dilation treatments for dysphagia, (average 1.36/patient). Twenty one (41.2%) patients received repeat dilations for recurrent symptoms. Savary dilators were used in 18 patients, Maloney bougie in 32 patients and balloon dilators in 5 patients. Post dilation inspection was documented in 15 patients. Mucosal tears were reported in seven patients (13.72%) on simple passage of the scope, food disimpaction or after dilation. No perforations occurred. Blood on dilator was seen in 10 patients (19.60%). Two patients (3.9%) developed significant chest pain after dilation requiring analgesia and admission for observation, perforation was ruled out in those patients. Seventeen patients were prescribed swallowed topical steroids, all after their first esophageal dilation. Of 28 patients seen in follow up visits after dilation treatments, 22 reported symptomatic improvement. Dysphagia recurred in 12 patients. Time to recurrence ranged from 2 weeks to six months after dilation. Further analysis of this review will be presented at the meeting.
Conclusions: Although patients with EE are at increased risk of endoscopic complications including tears and rarely perforations, dilation treatment for symptomatic relief in conjunction with medical treatment is reasonably safe.

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