Unexpected Proximal Strictures and Narrowing are Commonly Found During Esophageal Dilation for Eosinophilic Esophagitis

Goal: To determine the proportion of EoE patients who undergo esophageal dilation and demonstrate the dilation effect in an unexpected area. Background: Esophageal strictures and narrowing requiring dilation are common in eosinophilic esophagitis (EoE). However, endoscopy has low sensitivity for detecting these findings. Study: In this retrospective cohort study, we identified EoE patients who underwent esophageal dilation over 1 year. Reports were reviewed for unexpected dilation effect (defined as an intentional stretch or tear of the esophagus resulting from dilation in an area other than what was targeted for dilation). Dilation details and frequency of expected and unexpected dilation effects were calculated, and groups with and without unexpected dilation effects were compared. Results: Of 189 patients who underwent dilation, 69 (37%) had an unexpected dilation effect. While demographics and symptoms were similar across groups, patients with an unexpected dilation effect were younger at the time of endoscopy (39.8±13.0 vs. 46.1±14.6 y; P =0.004). Overall, most clinically identified strictures were at the GEJ (73%). However, unexpected dilation effect strictures were more common at UES (58% vs. 8%; P <0.001) and proximally (35% vs. 13%; P <0.001). There were no other differences in endoscopic findings, treatments, or treatment response between groups. Conclusions: Over a third of EoE patients undergoing esophageal dilation for strictures or narrowing experienced an unexpected dilation effect, most of which occurred in the proximal esophagus or UES. Providers should be cognizant that EoE patients have multifocal, often unappreciated, stricture locations, particularly proximally, and should opt for a technique that dilates the entire esophagus.