EGD Masterclass: EoE, Strictures, and Pre-malignant Gastric Conditions (On-demand) | January 2023-Hirano_Esoinophilic Esophagitis

Hirano_Esoinophilic Esophagitis_Endoscopic Assessment and Dilation

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This document discusses the assessment and management of strictures in eosinophilic esophagitis (EoE). The author, Ikuo Hirano, MD, provides an overview of different methods to assess esophageal strictures, including barium esophagram, endoscopy, impedance planimetry, TTS balloon pullback, and dilation effect. The document highlights that endoscopy has poor sensitivity for detecting esophageal strictures in EoE compared to radiologic imaging.<br /><br />The document also emphasizes the importance of assessing strictures in EoE and provides practical tips for both patient and technical considerations in stricture management. Patients need to be informed about the anticipated number and frequency of dilation sessions, the risk of esophageal perforation, and potential post-dilation symptoms such as odynophagia and chest pain. Technical considerations include the use of TTS balloon dilation for focal strictures and Savary dilators for long strictures. It is recommended to terminate dilation sessions once an "adequate" mucosal disruption has been achieved.<br /><br />The document includes a case series of 50 adults with EoE who underwent BougieCap dilation, which demonstrated successful dilation with increased diameter and symptom response. The advantages of BougieCap dilation include tactile and optical feedback and disposability, although potential cap detachment and limited testing in narrow caliber are noted as disadvantages.<br /><br />The document also discusses the efficacy and safety of esophageal dilation in EoE. A meta-analysis of 1820 dilations in 845 patients showed clinical improvement in 95% of cases, with a low rate of perforation (0.38%) and hospitalization (0.67%). The AGA-JTF guidelines suggest endoscopic dilation for patients with dysphagia from a stricture associated with EoE.<br /><br />In summary, this document provides insights into the assessment and management of strictures in EoE. It highlights the limitations of endoscopy in detecting strictures and provides practical tips for both patient and technical considerations in stricture management. The efficacy and safety of esophageal dilation are emphasized, supported by a meta-analysis and guidelines.

Keywords

strictures

eosinophilic esophagitis

endoscopy

radiologic imaging

dilation sessions

esophageal perforation

BougieCap dilation

efficacy

safety

dysphagia