Michael Ansstas, MD1, Daniel Lew, MD1, Dayna Early, MD, FACG2
1Cedars-Sinai Medical Center, Los Angeles, CA; 2Barnes-Jewish Hospital at Washington University, St. Louis, MO
Introduction: Eosinophilic esophagitis (EOE) is one of the most common causes of dysphagia and food impaction in the last two decades. Medical therapy including proton pump inhibitors (PPI), topical steroids, and diet can help, but if an esophageal stricture is present, then dilation may be necessary. The safety and efficacy of stricture dilation in EOE have been shown, but there is limited data on factors that can predict if patients will require multiple dilations.
The objectives of this study were to determine the frequency and predictors of requiring multiple dilations in patients with EOE.
Methods: A retrospective study from 2003-2018 was performed at a tertiary care center. Patients included in this study required a pathologic diagnosis of EOE ( >15 eosinophils per high power field), and required an esophageal stricture. The response was defined as the absence of symptoms. Adverse events included perforation.
Results: A total of 34 patients (21 men, 13 women) were included in the study. The median age was 43 years (range, 18-65). Follow-up time was 5.8 years. All patients underwent either a Savary dilation or pressure balloon dilation. Table 1 lists the characteristics of the strictures and balloon dilations. 8 patients required only one dilation session with 100% response rate, which defined. All patients were on PPI .9 patients did not have adjunctive therapy, while 21 patients used topical steroids, 3 patients used 6-food elimination diet, and 1 patient used both topical steroids and 6-food elimination diet. 5 patients had an 8mm stricture that was not able to be traversed with the endoscope, requiring a median of 2 sessions (range 2, 3) of dilation. Table 2 shows the characteristics of the strictures stratified by the number of sessions. Table 3 shows the number of sessions stratified by the length of the stricture. There were no perforations.
Discussion: Esophageal dilation has a definitive role in the management of EoE. It is indicated if the patients do not respond to pharmacological or dietary therapy. In this study, it seems the major predictor factor for frequent esophageal dilation is the length of the stricture. The treatment including corticosteroid inhaler or 6-food elimination is not helpful when the length of stricture more than 1 cm.
Citation: Michael Ansstas, MD; Daniel Lew, MD; Dayna Early, MD, FACG. P2099 - PREDICTOR FACTORS FOR DILATION TREATMENT IN STRICTURE DUE TO EOSINOPHILIC ESOPHAGITIS. Program No. P2099. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.