Effectiveness of empirical dilation for persistent obstructive symptoms in eosinophilic esophagitis despite histological remission.

BACKGROUND

Some patients with eosinophilic esophagitis (EoE) remain symptomatic despite histological remission. In absence of strictures at endoscopy, empirical dilation has been suggested, however no data on usefulness are available.

AIMS: To investigate effectiveness of empirical dilation.

METHODS

Retrospective analysis of all EoE patients who achieved histological remission at our Institution between July 2018 and February 2024. Patients with persistent dysphagia and/or bolus impaction underwent dilation irrespective of stricture at endoscopy. Follow-up of ≥6 months was required.

RESULTS

Forty-six patients (median age 42 years, 25 men) were included. Thirty-seven had no stricture and 9 had a stricture (i.e., S1 or R3 according to EREFS score). In the former group, 23/37 patients became asymptomatic whereas 14 were still symptomatic and underwent empirical dilation, clinically effective in 13 of them. A second dilation was needed in 2, after 25 and 31 months. In the latter group all patients underwent dilation and achieved clinical remission. All 45 patients remained in clinico-histological remission during a 14(8-46) months follow-up, with no change in medical treatment and a final I-SEE score of 1(0-1).

CONCLUSIONS

Empirical esophageal dilation is highly effective when dysphagia/bolus impaction persists despite histological remission and should be considered before escalating treatment.