Gastroenterology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
Aliment Pharmacol Ther. 2013 Oct;38(7):713-20. doi: 10.1111/apt.12438. Epub 2013 Aug 5.
Oesophageal dilation is one of the most effective options in the management of symptoms of eosinophilic oesophagitis (EoE). However, earlier reports described an increased rate of complications.
To perform a meta-analysis of population-based studies of the risks associated with dilation and the clinical efficacy and duration of response to dilation in EoE.
Using MEDLINE and EMBASE, a systematic search was performed for published articles since 1977 describing cohort or randomised controlled trials of dilation in EoE. Summary estimates, including 95% confidence interval (CI), were calculated for the occurrence of complications associated with dilations (perforations, haemorrhage, chest pain, lacerations) and percentage of patients with symptom improvement following dilation. Heterogeneity was calculated using the I² statistic.
The search resulted in 232 references, of which 9 studies were included in the final analysis. The studies described 860 EoE patients, of whom 525 patients underwent at least one oesophageal dilation and a total of 992 dilations. There were three cases of perforation (95% CI 0-0.9%, I² 0%) and one haemorrhage (95% CI 0-0.8%, I² 0%). Six studies reported postprocedural chest pain in 2% of cases (95% CI 1-3, I² 53%). Clinical improvement from dilation occurred in 75% of patients (95% CI 58-93%, I² 86%).
Dilation in patients with eosinophilic oesophagitis is a safe procedure with a low rate of serious complications (<1%), and seems to result in at least a short-term improvement of symptoms in the majority of patients.
食管扩张是治疗嗜酸性食管炎（EoE）症状的最有效方法之一。然而，早期的报告描述了并发症发生率增加。
对 EoE 扩张相关风险以及扩张的临床疗效和反应持续时间进行基于人群的研究进行荟萃分析。
使用 MEDLINE 和 EMBASE 对自 1977 年以来发表的描述 EoE 扩张的队列或随机对照试验的文章进行系统检索。计算并发症（穿孔、出血、胸痛、撕裂）发生率和扩张后症状改善的患者百分比的汇总估计值，包括 95%置信区间（CI）。使用 I² 统计量计算异质性。
搜索结果产生了 232 篇参考文献，其中 9 项研究被纳入最终分析。这些研究描述了 860 例 EoE 患者，其中 525 例至少接受了一次食管扩张，共进行了 992 次扩张。有 3 例穿孔（95%CI 0-0.9%，I² 0%）和 1 例出血（95%CI 0-0.8%，I² 0%）。6 项研究报告了 2%的病例术后胸痛（95%CI 1-3，I² 53%）。扩张后 75%的患者症状得到改善（95%CI 58-93%，I² 86%）。
在嗜酸性食管炎患者中，扩张是一种安全的操作，严重并发症的发生率较低（<1%），并且似乎至少在大多数患者中导致症状的短期改善。
