Resident University of North Carolina Chapel Hill, NC
Award: Presidential Poster Award
Sydney Greenberg, MD1, Nicole Chang, BS2, S. Ryanne Corder3, Craig C. Reed, MD, MSCR1, Swathi Eluri, MD, MSCR2, Evan S. Dellon, MD, MPH2; 1University of North Carolina, Chapel Hill, NC; 2University of North Carolina School of Medicine, Chapel Hill, NC; 3University of North Carolina School of Medicine, Shelby, NC
Introduction: Esophageal dilation is an important treatment in eosinophilic esophagitis (EoE) patients with fibrostenosis. However, little is known about dilation alone as a long-term treatment approach. We aimed to assess the safety and efficacy of esophageal dilation alone as a treatment started in patients with EoE. Methods: We conducted a retrospective cohort study of patients with an incident diagnosis of EoE in the UNC EoE clfinicopathologic database. Patient were included if esophageal dilation was performed. They were divided in two groups. The first was dilation only, defined as patient who underwent > 3 dilations as either sole treatment for EoE or for histologically refractory disease ( > 15 eos/hpf) to other EoE anti-inflammatory treatments. The second was routine dilation, define as < 3 dilations or histologic response (< 15 eos/hpf) to other treatments. Characteristics of the two groups were compared and outcomes for the dilation only group assessed. Results: Of 205 patients included, 53 (26%) were treated with esophageal dilation alone. The dilation alone patients were younger (33 vs 41 yrs, p = 0.003), had a narrower baseline esophageal diameter (9.8 vs 11.5mm, p = 0.005), underwent more dilations (7.7 vs 3.4, p < 0.001), but achieved a smaller final diameter (15.7 vs 16.7mm, p = 0.01) compared to routine dilation care (Table). Reasons for dilation alone included treatment non-response (75%), poor adherence (40%), and patient choice (23%). With this strategy, 30 patients (57%) had a global symptom respond. Of the 408 dilations in this group, there were no deaths perforations as a result of dilation, 6 ER visits for evaluation of chest pain, 2 for inability to tolerate PO requiring IV hydration, and 1 episode of post-dilation bleeding requiring transfusion. Over a median follow-up of 1001 day (IQR 581-1710), 4 had food impaction requiring ER visit, with 1 resulting in a contained perforation managed non-operatively. In sum, 7 patients required hospitalization. Additionally, 26 patients (49%) participated in at least 1 clinical trial. Discussion: In patients with strictures and difficult to treat EoE, esophageal dilation alone can be used as a long-term treatment strategy and as a bridge to clinical trials, with close follow-up and monitoring for complications. Patients using this strategy were more likely to be younger, have narrower initial esophageal diameter, and be unresponsive to other treatments.
Table - Baseline characteristics of patients receiving routine dilation care and the dilation alone strategy