Systematic Review With Meta-analysis

Endoscopic Dilation Is Highly Effective and Safe in Children and Adults With Eosinophilic Oesophagitis

F. J. Moawad; J. Molina-Infante; A. J. Lucendo; S. E. Cantrell; L. Tmanova; K. M. Douglas

Disclosures

Aliment Pharmacol Ther. 2017;46(2):96-105. 

In This Article

Abstract and Introduction

Abstract

Background: Oesophageal dilation is frequently used as an adjunct treatment to alleviate symptoms that develop from fibrostenotic remodelling in eosinophilic oesophagitis (EoE). Earlier reports described an increased risk of complications associated with dilation.

Aim: Perform a systematic review and meta-analysis to assess the efficacy and safety of endoscopic dilation in children and adults with EoE.

Methods: Professional librarians searched MEDLINE, EMBASE, the Cochrane library, Scopus, and Web of Science for articles in any language describing studies of dilation in EoE through December 2016. Studies were selected and data were abstracted independently and in duplicate. Random effects modelling was used to generate summary estimates for clinical improvement and complications (haemorrhage, perforation, hospitalisation, and death).

Results: The search resulted in 3495 references, of which 27 studies were included in the final analysis. The studies described 845 EoE patients, including 87 paediatric patients, who underwent a total of 1820 oesophageal dilations. The median number of dilations was 3 (range: 1–35). Clinical improvement occurred in 95% of patients (95% CI: 90%-98%, I 2: 10%, 17 studies). Perforation occurred in 0.38% (95% CI: 0.18%-0.85%, I 2: 0%, 27 studies), haemorrhage in 0.05% (95% CI: 0%-0.3%, I 2: 0%, 18 studies), and hospitalisation in 0.67% (95% CI: 0.3%-1.1%, I 2: 44%, 24 studies). No deaths occurred (95% CI: 0%-0.2% I 2: 0%, 25 studies).

Conclusions: Endoscopic dilation is consistently effective in children and adults with EoE, resulting in improvement in 95% of patients with very low rates (<1%) of major complications.

Introduction

Eosinophilic oesophagitis (EoE) is a chronic inflammatory disorder of the oesophagus, which is increasingly reported in children and adults.[1,2] This condition is considered a particular form of food allergy, in which proton pump inhibitor (PPI) therapy, topical steroids and specialised diets are effective in inducing and maintaining disease remission.[3–9] EoE has become the most common cause of dysphagia and food impaction in young adults.[10,11] Over time, features of oesophageal remodelling develop leading to a diffusely narrow calibre oesophagus and dominant strictures which may cause persistent dysphagia and require oesophageal dilation.[12–15]

Despite no impact on oesophageal inflammation, oesophageal dilation is one of the most effective options in the management of dysphagia of EoE patients with fibrostenotic features.[16] Earlier reports on performing dilation in patients with EoE described a higher than expected rate of complications, making dilation a less attractive approach in EoE.[17–20] Several more recent studies, however, have reported dilation to be a safe procedure.[21–23] In a previous meta-analysis, we found that major complications occurred in <1% of EoE patients undergoing dilation and that 75% of patients experienced clinical improvement.[16] The meta-analysis was limited to a relatively small number of studies and was restricted to an adult population. Since then, multiple centers have published data on dilation in EoE,[24–26] including recent studies on paediatric cohorts.[27–29]

To expand on and update our previous publication, we performed a systematic review and meta-analysis assessing the efficacy and safety of endoscopic dilation in children and adults with EoE.

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