Introduction Disease severity assessment in eosinophilic oesophagitis (EoE) is limited by the poor correlation of endoscopic appearance and histological eosinophil density with symptoms. Our aim is to ascertain whether having a measurement of oesophageal wall distensibility (using the EndoFLIP device) helps clinical decision making in the management of patients with EoE.
Methods Dysphagic patients with proven/suspected EoE were assessed by upper gastrointestinal endoscopy, oesophageal biopsies, clinical history, weight, and medication history. EndoFLIP assessment was carried out if symptoms persisted despite medical treatment or if there was an uncertain diagnosis. Assessment was performed under general anaesthetic. The 8 cm EndoFLIP balloon was inflated in the lower oesophagus, first to 20, then 30 and up to 40 ml of water according to oesophageal wall distensibility. After balloon emptying and repositioning in the upper oesophagus, the measurements were repeated. Oesophageal diameter was recorded at 5 mm intervals and distensibility calculated as changes in cross-sectional area per mm Hg. If the lumen was poorly distensible and <11 mm across, a through-the-scope balloon dilator was used to expand the areas depicted by EndoFLIP as being poorly compliant. Repeat EndoFLIP testing immediately after dilation revealed the improvement in distensibility. Patients were followed up at 3 months.
Results 6 patients in total were included, five of whom had biopsy proven EoE. In all six patients we found the EndoFLIP useful in guiding management. Two of the five patients with EoE were found to have poor oesophageal distensibility and underwent dilatation, following which a clear improvement in distensibility was seen. This correlated with an improvement in symptoms at follow-up. The remaining three patients with proven EoE had normal distensibility measurements and therefore did not undergo dilatation as a result of EndoFLIP testing. The single patient without EoE had normal distensibility measurements. Dilatation was undertaken following tertiary centre consultation on the basis of high-resolution manometry testing but symptoms returned after 3 months. There were no difficulties in performing the EndoFLIP test. There was a single complication of oesophageal mucosal tear following dilatation, which was of no clinical significance.
Conclusion Measuring the oesophageal wall distensibility may become a useful tool in the clinical assessment of EoE and may help to define the need for oesophageal dilatation and predict the outcome of such intervention.
Competing interests A Simpson: None declared, M Wilson: None declared, A Ellefson Employee of: Ardmore Healthcare Limited, S Colley: None declared, S Attwood: None declared.
Reference 1. Kwiatek MA, Hirano I, Kahrilas PJ, et al. Mechanical properties of the esophagus in osinophilic esophagitis. Gastroenterology 2011;140:82–90.
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