title: Role of endoscopic esophageal dilation in managing eosinophilic esophagitis: A systematic review and meta-analysis.
abstract: BACKGROUND
  Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder of the esophagus characterized by mucosal eosinophilic infiltration. Topical glucocorticoids are considered standard line of treatment, whereas endoscopic dilations are performed for patients presenting with treatment-resistant disease or manifestations of dysphagia and/or food impactions. Efficacy and safety of esophageal dilation in these patients are currently unclear.
  
  
  OBJECTIVE
  Primary outcomes were to evaluate the efficacy, adverse events, and mortality rates of endoscopic esophageal dilation in patients with EoE.
  
  
  METHODS
  STUDY SELECTION CRITERIA:: Studies that reported the use of esophageal dilation in EoE patients were included in this meta-analysis.
  
  
  METHODS
  Articles were searched in Medline, Pubmed, and Ovid journals. Two authors independently searched and extracted data. The study design was written in accordance to PRISMA statement. Clinical improvement was defined as patient-reported symptom relief noted by the authors of individual studies. The symptoms were assessed on various nonstandardized, however, relevant questionnaires that were deemed appropriate by the senior authors of individual studies.
  
  
  METHODS
  Pooled proportions were calculated using fixed- and random-effects model. I statistic was used to assess heterogeneity among studies.
  
  
  RESULTS
  Initial search identified 491 reference articles, in which 39 articles were selected and reviewed. Data were extracted from 14 studies (N = 1607) using esophageal dilation for EoE management, which met the inclusion criterion. Mean age of patients was 41years. Pooled patients included 75% males. The pooled proportion of patients that showed clinical improvement with esophageal dilations, after the median follow-up period of 12 months, was 84.95%. No procedure-related deaths were noted. The pooled proportion of patients with post procedural esophageal perforation, chest pain, hospitalization, deep mucosal tear (involving muscularis propria), small mucosal tear, and hemorrhage were 0.61%, 0.06%, 0.74%, 4.04%, 22.32%, and 0.38% respectively. I (inconsistency) was 0% (95% confidence interval [CI] = 0-49.8) and Egger: bias was 0.06 (95% CI = -0.30 to 0.42).
  
  
  CONCLUSIONS
  In patients with conformed diagnosis of EoE, endoscopic esophageal dilation seems to be an effective and safe treatment option. Majority patients with chest pain and deep mucosal tears did not require hospitalization and symptoms were self-limiting.
authors.affiliation: Department of Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL Department of Medicine, Apogee physicians, Genesis Medical Center, Davenport, IA Division of Gastroenterology and Hepatology, Kansas City Veteran Affairs Medical Center, Kansas City, MO Department of Medicine, NTR University of Health Sciences, Vijayawada, Andhra Pradesh, India Department of Gastroenterology and Hepatology, Emory University School of Medicine, Atlanta, GA Division of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL.
authors.forename: Harsha
authors.initials: H
authors.lastname: Moole
authors.forename: Kavitha
authors.initials: K
authors.lastname: Jacob
authors.forename: Abhiram
authors.initials: A
authors.lastname: Duvvuri
authors.forename: Vishnu
authors.initials: V
authors.lastname: Moole
authors.forename: Sowmya
authors.initials: S
authors.lastname: Dharmapuri
authors.forename: Raghuveer
authors.initials: R
authors.lastname: Boddireddy
authors.forename: Achuta
authors.initials: A
authors.lastname: Uppu
authors.forename: Srinivas R
authors.initials: SR
authors.lastname: Puli
mesh_terms: D004106:Dilatation; D057765:Eosinophilic Esophagitis / Q000628:therapy*; D004945:Esophagoscopy; D006801:Humans; D016896:Treatment Outcome