Background & Aims: Little is known about esophageal dilation as a long-term treatment eosinophilic esophagitis (EoE). We examined the impact of a “dilate and wait” strategy on symptoms and safety of patients with EoE.
Methods: This retrospective cohort study included two groups of EoE patients: those who underwent a dilation-predominant approach, defined as >3 dilations as EoE sole therapy or for histologically refractory disease (>15 eos/hpf); and those who had routine care, defined as <3 dilations or histologic response. Characteristics of the groups were compared and outcomes for the dilation-only group assessed.
Results: Of 205 patients, 53 (26%) received the dilation-predominant strategy (n=408 dilations total), most commonly because of histologic treatment non-response (75%). These patients were younger (33 vs 41 yrs, p=0.003), had a narrower baseline esophageal diameter (9.8 vs 11.5mm, p=0.005), underwent more dilations (7.7 vs 3.4, p <0.001), but achieved a smaller final diameter (15.7 vs 16.7mm, p=0.01) compared to routine care. With this strategy, 30 patients (57%) had ongoing symptom improvement, with esophageal caliber change independently associated with symptom response (aOR 1.79; 95%CI 1.17-2.78); 26 (49%) used the strategy as a bridge to clinical trials. Over a median follow-up of 1001 days (IQR 581-1710), there were no deaths or dilation-related perforations, but there were 9 ER visits, including 1 for post-dilation bleeding and 4 for food impaction.
Conclusions: A dilation-predominant long-term treatment strategy allows for symptom control or bridge to clinical trials for patients with difficult to treat EoE. Close follow-up and monitoring for complications is required.
Orodispersible budesonide tablets for the treatment of eosinophilic esophagitis: a review of the latest evidence