Occurrence of and risk factors for complications after endoscopic dilation in eosinophilic esophagitis.
BACKGROUND
Several small series have suggested an increased risk of complications associated with esophageal dilation in patients with eosinophilic esophagitis (EoE).


OBJECTIVE
To quantitate the risk and identify risk factors for esophageal complications in dilation in EoE patients.


METHODS
Retrospective, uncontrolled, single-center study.


METHODS
Tertiary referral hospital.


METHODS
A total of 161 EoE patients (mean ± standard deviation age 44.3 ± 15.3 years, 112 men, 49 women, 150 white patients, 10 unknown, 1 Asian).


METHODS
Through-the-scope balloon or Savary dilation of EoE.


METHODS
The rate of complications defined as deep mucosal tear, major bleeding, or perforation, and determination of risk factors for complications.


RESULTS
A total of 293 dilations were performed in 161 patients. Complications reported were deep mucosal tear in 9.2% (n = 27), major bleeding in 0.3% (n = 1), and immediate perforation in 1.0% (n = 3). All patients with perforations were successfully treated medically without surgery (mean ± standard deviation hospital stay 5.3 ± 3.2 days). Factors associated with an increased risk of complications were luminal narrowing in the upper (odds ratio [OR], 5.62; 95% CI, 2.07-15.26; P < .001) and middle third of the esophagus (OR, 4.93; 95% CI, 1.64-14.83; P < .005) compared with lower third, luminal stricture unable to be traversed with a standard upper endoscope (OR, 2.48; 95% CI, 1.06-5.83; P = .037), and use of Savary dilator (OR, 2.63; 95% CI, 1.18-5.83; P = .018).


CONCLUSIONS
Retrospective design, uncontrolled study.


CONCLUSIONS
Deep mucosal tears are common after dilation (9%), but the risk of immediate transluminal perforation with EoE is approximately 1%. The risk of severe complications is increased in patients with more proximal stricture and strictures that initially prevent endoscope passage.
Divisions of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Kee Wook
KW
Jung
Nancy
N
Gundersen
Jana
J
Kopacova
Amindra S
AS
Arora
Yvonne
Y
Romero
David
D
Katzka
Dawn
D
Francis
Julie
J
Schreiber
Ross A
RA
Dierkhising
Nicholas J
NJ
Talley
Thomas C
TC
Smyrk
Jeffrey A
JA
Alexander
D000328:Adult; D002404:Catheterization / Q000009:adverse effects*; D057765:Eosinophilic Esophagitis / Q000628:therapy*; D004939:Esophageal Perforation / Q000453:epidemiology*; D004940:Esophageal Stenosis / Q000150:complications*; D004945:Esophagoscopy / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology*; D006801:Humans; D022125:Lacerations / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000293:injuries; D012189:Retrospective Studies; D012307:Risk Factors