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.