title: Meta-analysis: the safety and efficacy of dilation in eosinophilic oesophagitis.
abstract: BACKGROUND
  Oesophageal dilation is one of the most effective options in the management of symptoms of eosinophilic oesophagitis (EoE). However, earlier reports described an increased rate of complications.
  
  
  OBJECTIVE
  To perform a meta-analysis of population-based studies of the risks associated with dilation and the clinical efficacy and duration of response to dilation in EoE.
  
  
  METHODS
  Using MEDLINE and EMBASE, a systematic search was performed for published articles since 1977 describing cohort or randomised controlled trials of dilation in EoE. Summary estimates, including 95% confidence interval (CI), were calculated for the occurrence of complications associated with dilations (perforations, haemorrhage, chest pain, lacerations) and percentage of patients with symptom improvement following dilation. Heterogeneity was calculated using the I² statistic.
  
  
  RESULTS
  The search resulted in 232 references, of which 9 studies were included in the final analysis. The studies described 860 EoE patients, of whom 525 patients underwent at least one oesophageal dilation and a total of 992 dilations. There were three cases of perforation (95% CI 0-0.9%, I² 0%) and one haemorrhage (95% CI 0-0.8%, I² 0%). Six studies reported postprocedural chest pain in 2% of cases (95% CI 1-3, I² 53%). Clinical improvement from dilation occurred in 75% of patients (95% CI 58-93%, I² 86%).
  
  
  CONCLUSIONS
  Dilation in patients with eosinophilic oesophagitis is a safe procedure with a low rate of serious complications (<1%), and seems to result in at least a short-term improvement of symptoms in the majority of patients.
authors.affiliation: Gastroenterology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA. Fouad.Moawad@us.army.mil
authors.forename: F J
authors.initials: FJ
authors.lastname: Moawad
authors.forename: J G
authors.initials: JG
authors.lastname: Cheatham
authors.forename: K J
authors.initials: KJ
authors.lastname: DeZee
mesh_terms: D002637:Chest Pain / Q000453:epidemiology / Q000209:etiology; D004106:Dilatation / Q000009:adverse effects / Q000379:methods*; D057765:Eosinophilic Esophagitis / Q000628:therapy*; D006801:Humans