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

Hirano_Esoinophilic Esophagitis_Endoscopic Assessment and Dilation

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This document discusses the assessment and management of esophageal strictures in patients with eosinophilic esophagitis (EoE). The first section emphasizes the limitations of endoscopy in detecting strictures compared to radiologic imaging. It provides data on the sensitivity and specificity of different radiologic esophageal diameters for stricture detection. <br /><br />The second section highlights patient and technical considerations in stricture management. It recommends outlining the number and frequency of dilation sessions based on stricture severity and target diameter. The section also discusses the risk of esophageal perforation, post-dilation symptoms, and the use of analgesia. Technical tips for dilation procedures are provided, including the use of TTS balloon dilation and Savary dilators. Additionally, it suggests obtaining mucosal biopsies after dilation to detect mucosal disruption. <br /><br />The third section presents a case series on BougieCap dilation in EoE, demonstrating its technical success and symptom response. The pros and cons of BougieCap dilation are discussed. <br /><br />The fourth section provides a meta-analysis of esophageal dilation in patients with EoE, showing clinical improvement in 95% of cases. The rates of perforation and hospitalization are also reported. The section references the AGA-JTF guidelines, which suggest endoscopic dilation for patients with dysphagia from EoE-associated strictures. <br /><br />The document concludes by summarizing key points on stricture management, including the limitations of endoscopic assessment, the effectiveness of different dilation techniques, and the overall safety of esophageal dilation in EoE patients.

Keywords

esophageal strictures

eosinophilic esophagitis

endoscopy

radiologic imaging

stricture management

dilation sessions

esophageal perforation

BougieCap dilation

meta-analysis

AGA-JTF guidelines