An audit of endoscopic complications in adult eosinophilic esophagitis.
OBJECTIVE
Eosinophilic esophagitis (EoE) in adults, characterized by the triad of dysphagia, a ringed esophagus, and mucosal eosinophilic infiltration, has associated complications that include vertical mucosal lacerations, instrumental perforation, and emesis-induced rupture. The aim of this study was to determine whether clinical, endoscopic, and histologic features can be used to predict the risk for development of these complications.


METHODS
A review was conducted of 36 patients with EoE. Complications were defined as mucosal lacerations or radiographic evidence of perforation.


RESULTS
The mean age at presentation was 33.9 years. Twenty-eight (78%) patients were men. Complications occurred in 11 patients (31%). There were 7 mucosal lacerations, 3 perforations, and 1 emesis-induced rupture. Strictures were reported in 7 of 11 complicated cases compared with 2 of 25 of uncomplicated cases. Dilatation procedures had been performed in 6 of 7 complicated cases associated with stricture. Biopsy specimens obtained from 7 of 9 patients with complications showed 40 or more eosinophils/high-power field. There were no statistical differences between complicated and uncomplicated patients regarding demographics, clinical features, endoscopic characteristics, or histopathologic findings.


CONCLUSIONS
EoE is a high-risk disorder with a range of complications. Although demographics, clinical presentation, and endoscopic features cannot distinguish risk, the presence of stricture, a longer duration of symptoms, and a greater density of eosinophilic infiltration suggest increased risk. The density of eosinophilic infiltration cannot be determined prospectively; therefore, the performance of endoscopy and subsequent dilatation should be deferred until biopsy specimens are reviewed or treatment is completed.
Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Matthew S
MS
Cohen
Adam B
AB
Kaufman
Juan P
JP
Palazzo
Daniel
D
Nevin
Anthony J
AJ
Dimarino
Sidney
S
Cohen
D001706:Biopsy; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004802:Eosinophilia / Q000150:complications* / Q000473:pathology; D004941:Esophagitis / Q000150:complications* / Q000473:pathology; D004947:Esophagus / Q000473:pathology*; D006801:Humans; D011379:Prognosis; D012307:Risk Factors; D012422:Rupture, Spontaneous; D014839:Vomiting / Q000209:etiology*