Endoscopy in eosinophilic esophagitis: “feline” esophagus and perforation risk

Kaplan, Mitchell; Mutlu, Ece; Jakate, Shriram; Bruninga, Keith; Losurdo, John; Losurdo, Joseph; Keshavarzian, Ali

doi:10.1016/s1542-3565(03)00222-2

Cited by 172 publications

(114 citation statements)

References 18 publications

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“…Chronic inflammatory eosinophilic infiltrates often lead to tissue remodeling and fibrosis, which causes luminal narrowing and loss of elasticity [8][9][10] . These morphological changes contribute to symptoms associated with EoE, such as chest pain, heartburn, acid reflux, feeding intolerance, and especially dysphagia and food impaction [11][12] . The methods of management can consist of dietary, pharmacological, and endoscopic interventions.…”

Section: Introductionmentioning

confidence: 99%

“…It also provides relief for patients whose symptoms have not responded to therapy with steroids, and those who do not want to be on long term medications or significantly restrict their diets [1,3,17] . Early descriptions of routine endoscopies and therapeutic interventions, such as dilation, in EoE patients indicated that the fragile and inelastic mucosa associated with the disease increased risks of deep tissue tears, lacerations, and perforations [4,11,12,14,18] . However, more recent studies with larger patient samples have indicated esophageal dilation as a safe therapy in EoE patients [16,[19][20][21] .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Esophageal dilations in eosinophilic esophagitis: A single center experience

Ukleja

Shiroky

Agarwal

et al. 2014

WJG

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AIM: To diagnose the clinical and histologic features that may be associated with or predictive of the need for dilation and dilation related complications; examine the safety of dilation in patients with eosinophilic esophagitis (EoE). METHODS:The medical records of all patients diagnosed with EoE between January 2002 and July 2010 were retrospectively reviewed. Esophageal biopsies were reexamined by an experienced pathologist to confirm the diagnosis (≥ 15 eos/hpf per current guidelines). Patients were divided into 2 groups: patients who did not receive dilation therapy and those who did. Demographics, clinical history, the use of pharmacologic therapy, endoscopic and pathology findings, and the number of biopsies and dilations carried out, if any, and their locations were recorded for each patient. The dilation group was further examined based on the interval between diagnosis and dilation, and whether or not a complication occurred. RESULTS:Sixty-one patients were identified with EoE and 22 (36%) of them underwent esophageal dilations for stricture/narrowing. The peak eos/hpf was significantly higher in patients who received a dilation (P = 0.04). Four (18% of pts.) minor complications occurred: deep mucosal tear 1, and small mucosal tears 3. There were no cases of esophageal perforations. Higher peak eos/hpf counts were not associated with increased risk of complications. CONCLUSION:Esophageal dilation appears to be a safe procedure in EoE patients, carrying a low complication rate. No correlation was found between the peak of eosinophil count and complication rate. Complications can occur independently of the histologic features. The long-term outcome of EoE treatment, with or without dilation, needs to be determined. © 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Balloon dilation; Dysphagia; Esophagus disorder; Esophageal stricture; Esosinophilic esophagitis Core tip: The field of gastroenterology does not currently have standardized treatment guidelines for eosinophilic esophagitis. Current data on the safety of dilations in patients with eosinophilic esophagitis (EoE) are conflicting and lack information on factors that influence whether or not a patient will require dilation. This study revealed that higher peak eos/hpf counts appear to influence whether or not an EoE patient will require dilation during the course of their treatment. However, complications appear to occur independently of the histologic features. Esophageal dilation appears to be a safe procedure in EoE patients, carrying a low complication rate.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Esophageal dilations in eosinophilic esophagitis: A single center experience

Ukleja

Shiroky

Agarwal

et al. 2014

WJG

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“…Food impaction necessitating endoscopic intervention is common. Mucosal rents and rarely perforations occur with simple passage of the endoscope [1] . We report a case of circumferential mucosal dissection in a young man with eosinophilic esophagitis.…”

Section: Introductionmentioning

confidence: 99%

Circumferential mucosal dissection and esophageal perforation in a patient with eosinophilic esophagitis

Liguori

Cortale²,

Cimino³

et al. 2008

WJG

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A young man with a previous history of episodes of mild solid food dysphagia was admitted with a total dysphagia. The esophagogastroduodenoscopy (EGDS) showed an extensive disruption of mucosal layer with a cul-desac in the lower part of the esophagus. Soon after the procedure, the patient suffered from an acute chest pain and subsequent CT scan demonstrated an intramural circumferential dissection of thoracic esophagus, and a mediastinal emphysema. An emergency right thoracotomy was performed, followed by a total esophagectomy with esophagogastroplasty and jejunostomy. The histopathology confirmed that mucosal and submucosal layers were circumferentially detached from muscular wall and showed an eosinophilic infiltration of the whole organ with necrosis and erosions of mucosal, submucosal and muscular layers. The diagnosis was esophageal perforation in eosinophilic esophagitis.

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“…5 In one series, 31% of EO patients suffered endoscopic complications of oesophageal laceration and rupture (8.3%).…”

Section: Contributorshipmentioning

confidence: 97%