Su1158 Through-the-Scope Hydrostatic Balloon Dilation of Strictures and Rings is Associated With Low Incidence of Perforation in Adults With Eosinophilic Esophagitis and Dysphagia: the Four-Year Experience of a Single Tertiary-Care Medical Center

Abstract

Background: Eosinophilic esophagitis (EoE) is an increasingly recognized esophageal disorder with symptoms that are dominated in adults by dysphagia. Dysphagia occurs primarily as a result of an anatomical obstruction from strictures, webs, and rings. Dilation of these lesions through various endoscopic modalities has been studied in adult EoE patients. Early studies demonstrated perforation rates as high as 5%, but more recent studies identify a perforation rate of <1%. The majority of the literature to date has focused on dilatation via Savary dilators; however, our institution favors the use of sequentially upsized through-thescope (TTS) balloon dilators applied in a static position and have experienced excellent clinical outcomes. We report our experience in detail here. Methods: The medical records of adult subjects (Age >18 years old) with the diagnosis of EoE (ICD-9 code 530.13, added 2008) at a single tertiary medical center were reviewed as part of an IRB-approved retrospective observational study. All subjects who received TTS balloon dilation for an obstructive anatomic lesion were included in this case series. Demographic data, endoscopy date, endoscopic findings, and maximum dilatation diameter were recorded. Results: 19 patients receiving a total of 21 dilations occurring between 2007-2011 met the inclusion criteria. One subject received three dilations, which were analyzed as separate and independent events. All patients presented with solid-food dysphagia. The table below lists information regarding each procedure in ascending age (∗ indicates the patient with multiple dilations). The median age at the time of dilation was 38 years old (range 18-73). They were predominantly male (15/21, 71%) and Caucasian (19/21, 90%). The maximum dilation size ranged from 15-20 mm. The most common indication for dilation was mucosal B-ring in the distal esophagus (13/21 cases), stricture (7/21), and concentric rings (1/21). There were no esophageal perforations among these cases. Conclusion: TTS balloon dilation of fibrostenotic lesions is safe and effective in the treatment of strictures and rings in adults with EoE. This series adds to the recent literature showing perforation rates lower than originally reported, regardless of dilatation method used (TTS versus Savary). This shift is likely due to increased awareness of the diagnosis and appropriate patient selection by the endoscopist. The simple technique and direct visualization could support the wider use of TTS balloon dilation if further studies replicate these findings. (Table presented).