嗜酸细胞性食管炎患者接受食管扩张术后的结局：Fibrostenotic表型的安全性、有效性和持久性
Outcomes of Esophageal Dilation in Eosinophilic Esophagitis: Safety, Efficacy, and Persistence of the Fibrostenotic Phenotype Thomas MRungeMD, MPH1, SwathiEluriMD1, Cary CCottonMPH1, Caitlin MBurkBA1
Outcomes of Esophageal Dilation in Eosinophilic Esophagitis: Safety, Efficacy, and Persistence of the Fibrostenotic Phenotype
Thomas M Runge MD, MPH1, Swathi Eluri MD1, Cary C Cotton MPH1, Caitlin M Burk BA1, John T Woosley MD, PhD2, Nicholas J Shaheen MD, MPH1,3and Evan S Dellon MD, MPH1,3
Abstract
Objectives:
Esophageal dilation is commonly performed in eosinophilic esophagitis (EoE), but there are few long-term data. The aims of this study were to assess the safety and long-term efficacy of esophageal dilation in a large cohort of EoE cases, and to determine the frequency and predictors of requiring multiple dilations.
Methods:
We conducted a retrospective cohort study in the University of North Carolina EoE Clinicopathological Database from 2002 to 2014. Included subjects met consensus diagnostic criteria for EoE. Clinical, endoscopic, and histologic features were extracted, as were dilation characteristics (dilator type, change in esophageal caliber, and total number of dilations) and complications. Patients with EoE who had undergone dilation were compared with those who did not and also stratified by whether they required single or multiple dilations.
Results:
Of 509 EoE patients, 164 were dilated a total of 486 times. Those who underwent dilation had a longer duration of symptoms before diagnosis (11.1 vs. 5.4 years,P<0.001). Ninety-five patients (58%) required >1 dilation (417 dilations total, mean of 4.4±4.3 per patient). The only predictor of requiring multiple dilations was a smaller baseline esophageal diameter. Dilation was tolerated well, with no major bleeds, perforations, or deaths. The overall complication rate was 5%, primarily due to post-procedural pain. Of 164 individuals dilated, a majority (58%or 95/164) required a second dilation. Of these individuals, 75%required repeat dilation within 1 year.
Conclusions:
Dilation in EoE is well-tolerated, with a very low risk of serious complications. Patients with long-standing symptoms before diagnosis are likely to require dilation. More than half of those dilated will require multiple dilations, often needing a second procedure within 1 year. These findings can be used to counsel patients with fibrostenotic complications of EoE.
Am J Gastroenterol2016; 111:206–213; doi:10.1038/ajg.2015.399; published online 12 January 2016
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