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A Systematic Review of the Risk of Perforation During Esophageal Dilation for Patients with Eosinophilic Esophagitis

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Abstract

Background

Eosinophilic esophagitis (EoE) is associated with tissue remodeling that can result in esophageal mucosal fragility, and esophageal dilation for patients with EoE is known to cause painful mucosal lacerations. Clinicians have been admonished that patients with EoE may be exceptionally predisposed to perforation with esophageal dilation, a notion supported primarily by case reports. We have conducted a systematic review of literature on esophageal dilation in EoE in an attempt to better define the risk of perforation.

Methods

We searched PubMed and abstracts presented at the annual scientific meetings of the American Gastroenterological Association and the American College of Gastroenterology to identify reports on esophageal dilation in EoE. We analyzed reports meeting the following criteria: (1) the diagnosis was established from esophageal biopsy specimens revealing ≥15 eosinophils/hpf, (2) esophageal dilation was described, (3) esophageal perforations described were the result of esophageal dilation.

Results

We identified 18 reports for inclusion in our systematic review. The studies comprised 468 patients who underwent a total of 671 endoscopic dilations. Esophageal mucosal tears were described in most cases, but there was only one perforation among the 671 dilations (0.1%).

Conclusions

Our systematic review does not reveal an inordinate frequency of esophageal perforation from dilation in patients with EoE, and it is not clear that dilation is any more hazardous for patients with EoE than for patients with other causes of esophageal stricture. Although esophageal dilation must be performed with caution in all patients, the risk of perforation in EoE appears to have been exaggerated.

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References

  1. Aceves SS, Ackerman SJ. Relationships between eosinophilic inflammation, tissue remodeling, and fibrosis in eosinophilic esophagitis. Immunol Allergy Clin N Am. 2009;29(1):197–211.

    Article  Google Scholar 

  2. Sgouros SN, Bergele C, Mantides A. Eosinophilic esophagitis in adults: what is the clinical significance? Endoscopy. 2006;38(5):515–520.

    Article  CAS  PubMed  Google Scholar 

  3. Liacouras CA. Eosinophilic esophagitis. Gastroenterol Clin N Am. 2008;37(4):989–998.

    Article  Google Scholar 

  4. Prasad GA, Alexander JA, Schleck CD, et al. Epidemiology of eosinophilic esophagitis over three decades in Olmsted County, Minnesota. Clin Gastroenterol Hepatol. 2009;7:1055–1061.

    Article  PubMed  Google Scholar 

  5. Veerappan GR, Perry JL, Duncan TJ, et al. Prevalence of eosinophilic esophagitis in an adult population undergoing upper endoscopy: a prospective study. Clin Gastroenterol Hepatol. 2009;7:420–426.

    Article  PubMed  Google Scholar 

  6. Aceves SS, Furuta GT, Spechler SJ. Integrated approach to treatment of children and adults with eosinophilic esophagitis. Gastrointest Endosc Clin N Am. 2008;18:195–217.

    Article  PubMed  Google Scholar 

  7. Bohm M, Richter JE. Treatment of eosinophilic esophagitis: overview, current limitations, and future direction. Am J Gastroenterol. 2008;103:2635–2644.

    Article  CAS  PubMed  Google Scholar 

  8. Sgouros SN, Bergele C, Mantides A. Eosinophilic esophagitis in adults: a systematic review. Eur J Gastroenterol Hepatol. 2006;18(2):211–217.

    Article  PubMed  Google Scholar 

  9. Cohen MS, Kaufman A, DiMarino AJ, et al. Eosinophilic esophagitis presenting as spontaneous esophageal rupture (Boerhaave’s syndrome). Clin Gastroenterol Hepatol. 2007;5(2):A24.

    Article  PubMed  Google Scholar 

  10. Riou PJ, Nicholson AG, Pastorino U. Esophageal rupture in a patient with idiopathic eosinophilic esophagitis. Ann Thoracic Surg. 1996;62(6):1854–1856.

    Article  CAS  Google Scholar 

  11. Kaplan M, Mutlu EA, Jakate S, et al. Endoscopy in eosinophilic esophagitis: “feline” esophagus and perforation risk. Clin Gastroenterol Hepatol. 2003;1:433–437.

    Article  PubMed  Google Scholar 

  12. Straumann A, Bussmann C, Zuber M, et al. Eosinophilic esophagitis: analysis of food impaction and perforation in 251 adolescent and adult patients. Clin Gastroenterol Hepatol. 2008;6:598–600.

    Article  PubMed  Google Scholar 

  13. Cohen MS, Kaufman AB, Palazzo JP, et al. An audit of endoscopic complications in adult eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2007;5:1149–1153.

    Article  PubMed  Google Scholar 

  14. Langdon DE. Corrugated ringed esophagus. Am J Gastroenterol. 1993;88:1461.

    CAS  PubMed  Google Scholar 

  15. Langdon DE. Corrugated ringed and too small esophagi. Am J Gastroenterol. 1999;94:542–543.

    Article  CAS  PubMed  Google Scholar 

  16. Vasilopoulos S, Murphy P, Auerbach A, et al. The small-caliber esophagus: an unappreciated cause of dysphagia for solids in patients with eosinophilic esophagitis. Gastrointest Endosc. 2002;55(1):99–106.

    Article  PubMed  Google Scholar 

  17. Straumann A, Spichtin HP, Grize L, et al. Natural history of primary eosinophilic esophagitis: a follow-up of 30 adult patients for up to 11.5 years. Gastroenterology. 2003;125:1660–1669.

    Article  PubMed  Google Scholar 

  18. Croese J, Fairley SK, Masson JW, et al. Clinical and endoscopic features of eosinophilic esophagitis in adults. Gastrointest Endosc. 2003;58:516–522.

    Article  PubMed  Google Scholar 

  19. Arora AS, Perrault K, Smyrk TC. Topical corticosteroid treatment of dysphagia due to eosinophilic esophagitis in adults. Mayo Clin Proc. 2003;78:830–835.

    Article  CAS  PubMed  Google Scholar 

  20. Straumann A, Rossi L, Simon HU, et al. Fragility of the esophageal mucosa: a pathognomonic endoscopic sign of primary eosinophilic esophagitis? Gastrointest Endosc. 2003;57:407–412.

    Article  PubMed  Google Scholar 

  21. Potter JW, Saeian K, Staff D, et al. Eosinophilic esophagitis in adults: an emerging problem with unique endoscopic features. Gastrointest Endosc. 2004;59:355–361.

    Article  PubMed  Google Scholar 

  22. Meyer GW. Eosinophilic esophagitis in a father and a daughter. Gastrointest Endosc. 2005;61:932.

    Article  PubMed  Google Scholar 

  23. Roberts-Thomson IC. Gastrointestinal: eosinophilic esophagitis. J Gastroenterol Hepatol. 2005;20:1299.

    Article  CAS  PubMed  Google Scholar 

  24. Cantu P, Velio P, Prada A, et al. Ringed oesophagus and idiopathic eosinophilic oesophagitis in adults: an association in two cases. Dig Liver Dis. 2005;37:129–134.

    Article  CAS  PubMed  Google Scholar 

  25. Eisenbach C, Merle U, Schirmacher P, et al. Perforation of the esophagus after dilation treatment for dysphagia in a patient with eosinophilic esophagitis. Endoscopy. 2006;38:E43–E44.

    Article  PubMed  Google Scholar 

  26. Pasha SF, DiBaise JK, Kim HJ, et al. Patient characteristics, clinical, endoscopic, and histologic findings in adult eosinophilic esophagitis: a case series and systematic review on the medical literature. Dis Esophagus. 2007;20:311–319.

    Article  CAS  PubMed  Google Scholar 

  27. Gonsalves N, Karmali K, Hirano I. Safety and response of esophageal dilation in adults with eosinophilic esophagitis (EE): a single center experience of 81 patients. Gastroenterology. 2007;132:A607.

    Google Scholar 

  28. Schoepfer AM, Gschossmann J, Scheurer U, et al. Esophageal strictures in adult eosinophilic esophagitis: dilation is an effective and safe alternative after failure of topical steroids. Endoscopy. 2008;40:161–164.

    Article  CAS  PubMed  Google Scholar 

  29. Dellon ES, Gibbs WB, Rubinas TC et al. Esophageal dilation in eosinophilic esophagitis: safety and predictors of clinical response and complications. Gastroenterology. 2009;S1863. A-280.

    Google Scholar 

  30. Shepherd DB, Slaughter JC, Vaezi MF. Eosinophilic esophagitis: dilate or medicate? Gastroenterology. 2009;S1869. A-281.

  31. Kumar KS, Smith JW. Eosinophilic esophagitis: the Ochsner clinic experience. Am J Gastroenterol. 2005;100(9):S41.

    Article  Google Scholar 

  32. Schoepfer AM, Gonsalves N, Bussmann C et al. Esophageal dilation in eosinophilic esophagitis: effectiveness, safety, and impact on the underlying inflammation. Am J Gastroenterol. 2009. doi:10.1038/ajg.2009.657.

  33. Spechler SJ. AGA technical review on treatment of patients with dysphagia caused by benign disorders of the distal esophagus. Gastroenterology. 1999;117:233–254.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This work was supported by the Office of Medical Research, Department of Veterans Affairs and the National Institutes of Health (R01-CA134571).

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Authors and Affiliations

  1. Department of Medicine, VA North Texas Healthcare System, Dallas, TX, USA

    John William Jacobs Jr. & Stuart Jon Spechler

  2. Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

    John William Jacobs Jr. & Stuart Jon Spechler

  3. Division of Gastroenterology (111B1), Dallas VA Medical Center, 4500 South Lancaster Road, Dallas, TX, 75216, USA

    Stuart Jon Spechler

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  1. John William Jacobs Jr.
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Correspondence to Stuart Jon Spechler.

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Jacobs, J.W., Spechler, S.J. A Systematic Review of the Risk of Perforation During Esophageal Dilation for Patients with Eosinophilic Esophagitis. Dig Dis Sci 55, 1512–1515 (2010). https://doi.org/10.1007/s10620-010-1165-x

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  • DOI: https://doi.org/10.1007/s10620-010-1165-x

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