A novel balloon pull-through technique for esophageal dilation in eosinophilic esophagitis (with video).

BACKGROUND: Eosinophilic esophagitis (EoE) is a chronic inflammatory condition that can be complicated by esophageal strictures requiring endoscopic dilation. Whereas recent data have advanced the notion that dilation can be done effectively with minimal morbidity, issues concerning safety and tolerability remain.
OBJECTIVE: To review our initial experience with a novel esophageal balloon pull-through technique for sizing and dilation in EoE as well as to present a video illustrating the methodology.
DESIGN: Case series.
SETTING: Tertiary-care referral center. PATIENTS: Thirteen patients with EoE. INTERVENTION: Balloon pull-through technique for esophageal dilation. MAIN OUTCOME MEASUREMENTS: Dilation effect, size, and complications (esophageal perforation, bleeding requiring endoscopic hemostasis, or severe chest pain requiring hospitalization).
RESULTS: Thirteen patients (7 men, 6 women; mean age 40 years, range 19-66 years) with EoE underwent dilation with the esophageal balloon pull-through technique. Resistance during the pull-through was encountered in 11 patients (85%), even though no discrete areas of narrowing were encountered. A tear was achieved in 9 patients (69%). Nine patients (69%) reported improvement in their dysphagia after dilation. There were no serious complications from the procedure. LIMITATIONS: Retrospective, single center, small patient numbers in this initial report.
CONCLUSIONS: The esophageal balloon pull-through technique for esophageal dilation in patients with EoE appears to be safe and effective. It is a rational approach to gauging the luminal diameter of the esophagus and treating strictures in patients with EoE and dysphagia, but further prospective study is required to confirm these initial results.