Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.
School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States.
Endoscopy. 2022 Mar;54(3):243-250. doi: 10.1055/a-1493-5627. Epub 2021 Jun 10.
Little is known about esophageal dilation as a long-term treatment approach for eosinophilic esophagitis (EoE). We examined the impact of a "dilate and wait" strategy on symptom management and safety of patients with EoE.
This retrospective cohort study included two patient groups: those who underwent a dilation-predominant approach (≥ 3 dilations as sole therapy or for histologically refractory disease [> 15 eos/hpf]); and those who had routine care (< 3 dilations or histologic response). Group characteristics were compared and outcomes for the dilation-only group assessed.
53/205 patients (26 %) received the dilation-predominant strategy (total 408 dilations), predominantly for histologic treatment nonresponse (75 %). These patients were younger (33 vs. 41 years; = 0.003), had a narrower baseline esophageal diameter (9.8 vs. 11.5 mm; = 0.005), underwent more dilations (7.7 vs. 3.4; < 0.001), but achieved a smaller final diameter (15.7 vs. 16.7 mm; = 0.01) vs. routine care. With this strategy, 30 patients (57 %) had ongoing symptom improvement, with esophageal caliber change independently associated with symptom response (adjusted odds ratio 1.79, 95 % confidence interval 1.16-2.78); 26 (49 %) used the strategy as a bridge to clinical trials. Over a median follow-up of 1001 days (interquartile range 581-1710), no deaths or dilation-related perforations occurred, but there were nine emergency room visits, including one for post-dilation bleeding and four for food impaction.
A dilation-predominant long-term treatment strategy allowed for symptom control or bridge to clinical trials for patients with difficult-to-treat EoE. Close follow-up and monitoring for complications are required.
对于嗜酸性食管炎（EoE），食管扩张作为一种长期治疗方法，人们知之甚少。我们研究了“扩张和等待”策略对 EoE 患者的症状管理和安全性的影响。
这项回顾性队列研究包括两组患者：一组采用以扩张为主的治疗方法（仅治疗或治疗组织学难治性疾病[>15 个 eos/hpf]时进行≥3 次扩张）；另一组接受常规治疗（<3 次扩张或组织学反应）。比较两组患者的特征，并评估仅扩张组的结果。
205 例患者中有 53 例（26%）接受了以扩张为主的治疗策略（共进行了 408 次扩张），主要是因为组织学治疗反应不佳（75%）。这些患者更年轻（33 岁比 41 岁；P=0.003），基线食管直径更窄（9.8 毫米比 11.5 毫米；P=0.005），扩张次数更多（7.7 次比 3.4 次；P<0.001），但最终直径更小（15.7 毫米比 16.7 毫米；P=0.01），与常规治疗相比。采用这种策略，30 例（57%）患者的症状持续改善，食管口径的变化与症状反应独立相关（调整后的优势比 1.79，95%置信区间 1.16-2.78）；26 例（49%）患者将该策略作为进入临床试验的桥梁。在中位数为 1001 天（581-1710 天）的随访期间，没有死亡或与扩张相关的穿孔，但有 9 次急诊就诊，包括 1 次扩张后出血和 4 次食物嵌塞。
对于治疗困难的 EoE 患者，以扩张为主的长期治疗策略可控制症状或为进入临床试验搭桥。需要密切随访和监测并发症。
