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.
Abbreviations:
CI (confidence interval), EoE (eosinophilic esophagitis)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: April 28, 2017
Accepted:
April 19,
2017
Received:
October 31,
2016
Footnotes
DISCLOSURE: The following authors received research support for this study from the National Institutes of Health: M. Dougherty, T. M. Runge, S. Eluri (award T32 DK007634); E. S. Dellon (award R01 DK101856). In addition, the following author disclosed financial relationships relevant to this publication: E. S. Dellon: Consultant for Adare, Banner, Receptos, Regeneron, Roche, and Shire; research funding recipient for Meritage, Miraca, Nutricia, Receptos, Regeneron, and Shire; educational grant recipient from Banner. All other authors disclosed no financial relationships relevant to this publication.
See CME section; p. 731.
If you would like to chat with an author of this article, you may contact Dr Dellon at [email protected] .
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© 2017 by the American Society for Gastrointestinal Endoscopy
