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Role of endoscopic esophageal dilation in managing eosinophilic esophagitis: A systematic review and meta-analysis

BACKGROUND: Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder of the esophagus characterized by mucosal eosinophilic infiltration. Topical glucocorticoids are considered standard line of treatment, whereas endoscopic dilations are performed for patients presenting with treatment-...

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Autores principales: Moole, Harsha, Jacob, Kavitha, Duvvuri, Abhiram, Moole, Vishnu, Dharmapuri, Sowmya, Boddireddy, Raghuveer, Uppu, Achuta, Puli, Srinivas R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5411180/
https://www.ncbi.nlm.nih.gov/pubmed/28383396
http://dx.doi.org/10.1097/MD.0000000000005877
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author Moole, Harsha
Jacob, Kavitha
Duvvuri, Abhiram
Moole, Vishnu
Dharmapuri, Sowmya
Boddireddy, Raghuveer
Uppu, Achuta
Puli, Srinivas R.
author_facet Moole, Harsha
Jacob, Kavitha
Duvvuri, Abhiram
Moole, Vishnu
Dharmapuri, Sowmya
Boddireddy, Raghuveer
Uppu, Achuta
Puli, Srinivas R.
author_sort Moole, Harsha
collection PubMed
description BACKGROUND: Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder of the esophagus characterized by mucosal eosinophilic infiltration. Topical glucocorticoids are considered standard line of treatment, whereas endoscopic dilations are performed for patients presenting with treatment-resistant disease or manifestations of dysphagia and/or food impactions. Efficacy and safety of esophageal dilation in these patients are currently unclear. AIMS: Primary outcomes were to evaluate the efficacy, adverse events, and mortality rates of endoscopic esophageal dilation in patients with EoE. METHODS: STUDY SELECTION CRITERIA: Studies that reported the use of esophageal dilation in EoE patients were included in this meta-analysis. DATA COLLECTION AND EXTRACTION: Articles were searched in Medline, Pubmed, and Ovid journals. Two authors independently searched and extracted data. The study design was written in accordance to PRISMA statement. Clinical improvement was defined as patient-reported symptom relief noted by the authors of individual studies. The symptoms were assessed on various nonstandardized, however, relevant questionnaires that were deemed appropriate by the senior authors of individual studies. STATISTICAL METHOD: Pooled proportions were calculated using fixed- and random-effects model. I(2) statistic was used to assess heterogeneity among studies. RESULTS: Initial search identified 491 reference articles, in which 39 articles were selected and reviewed. Data were extracted from 14 studies (N = 1607) using esophageal dilation for EoE management, which met the inclusion criterion. Mean age of patients was 41years. Pooled patients included 75% males. The pooled proportion of patients that showed clinical improvement with esophageal dilations, after the median follow-up period of 12 months, was 84.95%. No procedure-related deaths were noted. The pooled proportion of patients with post procedural esophageal perforation, chest pain, hospitalization, deep mucosal tear (involving muscularis propria), small mucosal tear, and hemorrhage were 0.61%, 0.06%, 0.74%, 4.04%, 22.32%, and 0.38% respectively. I(2) (inconsistency) was 0% (95% confidence interval [CI] = 0–49.8) and Egger: bias was 0.06 (95% CI = −0.30 to 0.42). CONCLUSIONS: In patients with conformed diagnosis of EoE, endoscopic esophageal dilation seems to be an effective and safe treatment option. Majority patients with chest pain and deep mucosal tears did not require hospitalization and symptoms were self-limiting
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spelling pubmed-54111802017-05-02 Role of endoscopic esophageal dilation in managing eosinophilic esophagitis: A systematic review and meta-analysis Moole, Harsha Jacob, Kavitha Duvvuri, Abhiram Moole, Vishnu Dharmapuri, Sowmya Boddireddy, Raghuveer Uppu, Achuta Puli, Srinivas R. Medicine (Baltimore) 4500 BACKGROUND: Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder of the esophagus characterized by mucosal eosinophilic infiltration. Topical glucocorticoids are considered standard line of treatment, whereas endoscopic dilations are performed for patients presenting with treatment-resistant disease or manifestations of dysphagia and/or food impactions. Efficacy and safety of esophageal dilation in these patients are currently unclear. AIMS: Primary outcomes were to evaluate the efficacy, adverse events, and mortality rates of endoscopic esophageal dilation in patients with EoE. METHODS: STUDY SELECTION CRITERIA: Studies that reported the use of esophageal dilation in EoE patients were included in this meta-analysis. DATA COLLECTION AND EXTRACTION: Articles were searched in Medline, Pubmed, and Ovid journals. Two authors independently searched and extracted data. The study design was written in accordance to PRISMA statement. Clinical improvement was defined as patient-reported symptom relief noted by the authors of individual studies. The symptoms were assessed on various nonstandardized, however, relevant questionnaires that were deemed appropriate by the senior authors of individual studies. STATISTICAL METHOD: Pooled proportions were calculated using fixed- and random-effects model. I(2) statistic was used to assess heterogeneity among studies. RESULTS: Initial search identified 491 reference articles, in which 39 articles were selected and reviewed. Data were extracted from 14 studies (N = 1607) using esophageal dilation for EoE management, which met the inclusion criterion. Mean age of patients was 41years. Pooled patients included 75% males. The pooled proportion of patients that showed clinical improvement with esophageal dilations, after the median follow-up period of 12 months, was 84.95%. No procedure-related deaths were noted. The pooled proportion of patients with post procedural esophageal perforation, chest pain, hospitalization, deep mucosal tear (involving muscularis propria), small mucosal tear, and hemorrhage were 0.61%, 0.06%, 0.74%, 4.04%, 22.32%, and 0.38% respectively. I(2) (inconsistency) was 0% (95% confidence interval [CI] = 0–49.8) and Egger: bias was 0.06 (95% CI = −0.30 to 0.42). CONCLUSIONS: In patients with conformed diagnosis of EoE, endoscopic esophageal dilation seems to be an effective and safe treatment option. Majority patients with chest pain and deep mucosal tears did not require hospitalization and symptoms were self-limiting Wolters Kluwer Health 2017-04-07 /pmc/articles/PMC5411180/ /pubmed/28383396 http://dx.doi.org/10.1097/MD.0000000000005877 Text en Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-sa/4.0 This is an open access article distributed under the Creative Commons Attribution-ShareAlike License 4.0, which allows others to remix, tweak, and build upon the work, even for commercial purposes, as long as the author is credited and the new creations are licensed under the identical terms. http://creativecommons.org/licenses/by-sa/4.0
spellingShingle 4500
Moole, Harsha
Jacob, Kavitha
Duvvuri, Abhiram
Moole, Vishnu
Dharmapuri, Sowmya
Boddireddy, Raghuveer
Uppu, Achuta
Puli, Srinivas R.
Role of endoscopic esophageal dilation in managing eosinophilic esophagitis: A systematic review and meta-analysis
title Role of endoscopic esophageal dilation in managing eosinophilic esophagitis: A systematic review and meta-analysis
title_full Role of endoscopic esophageal dilation in managing eosinophilic esophagitis: A systematic review and meta-analysis
title_fullStr Role of endoscopic esophageal dilation in managing eosinophilic esophagitis: A systematic review and meta-analysis
title_full_unstemmed Role of endoscopic esophageal dilation in managing eosinophilic esophagitis: A systematic review and meta-analysis
title_short Role of endoscopic esophageal dilation in managing eosinophilic esophagitis: A systematic review and meta-analysis
title_sort role of endoscopic esophageal dilation in managing eosinophilic esophagitis: a systematic review and meta-analysis
topic 4500
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5411180/
https://www.ncbi.nlm.nih.gov/pubmed/28383396
http://dx.doi.org/10.1097/MD.0000000000005877
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