Esophageal Dilation Demonstrates That the Majority of Esophageal Strictures Are Located in the Distal Esophagus in Adults With Eosinophilic Esophagitis

Abstract

Introduction: Dysphagia caused by esophageal stricture is the most common clinical presentation of eosinophilic esophagitis (EoE) in adults. Esophageal dilation is an accepted therapeutic modality to manage strictures that persist in spite of medical therapy. Mucosal disruption following dilation not only provides evidence of an effective dilation but also identifies the site of dominant stricture formation Methods: We conducted a retrospective chart review for EoE adults receiving care from a single provider at an urban university based medical center. Patients from 2000 to 2017 who had undergone esophageal dilation for their EoE symptoms were identified. Demographic and clinical information and endoscopic features and results of dilation were collected. Location of mucosal disruption after dilation was recorded in all cases. Disruptions located between 15-27.5 cm from the incisors were defined as proximal strictures, and those above 27.5 cm from the incisors as distal strictures. A disruption was considered proximal and distal if there were multiple mucosal lacerations identified with one localized proximally and another distally, or from a disruption in the mid-esophagus spanning above and below 27.5 cm. Major complications of esophageal perforation or GI bleeding requiring hospitalization or blood transfusion were assessed. Results: Of 640 EoE patients identified, 250 patients had undergone 718 dilations. The average number of dilations per patient was 2.87 ± 2.62 dilations. Among the 718 dilations, 152 (23%) had proximal disruptions, 118 (18%) had both proximal and distal, 317 (47%) had distal only, 110 (16%) had no disruptions. Among 250 patients receiving dilation, 150 (52%) had only disruptions in the distal esophagus. 58 (23%) had disruptions in both the proximal and distal esophagus, and 25 (10%) had only proximal disruptions. Overall, distal esophageal strictures were present in 75% whereas proximal strictures were present in 33% of patients. A single complication of a contained esophageal perforation occurred (0.14%) that was managed conservatively with antibiotics. No major bleeding complications were identified. Conclusion: (1) The results of the largest single center experience of esophageal dilation in EoE affirm that dilation is a safe procedure with low risk of major complications. (2) The majority of strictures in EoE occur in the distal rather than proximal esophagus. (3) We speculate that factors including gastroesophageal reflux may influence stricture formation in EoE.324_A Figure 1 No Caption available.324_B Figure 2 No Caption available.