Clinical Scenario

This protocol applies to patients with eosinophilic esophagitis (EoE) who have developed esophageal stricture or esophageal luminal narrowing that results in dysphagia — a fibrostenotic complication requiring a distinct management strategy beyond inflammation control alone.

Specific Condition

Esophageal stricture or luminal narrowing in EoE causes mechanical obstruction leading to dysphagia and food impaction. Endoscopic dilation is recommended as an adjunct to medical therapy for such strictures. Importantly, dilation alone does not address EoE disease activity; it must be performed alongside effective anti-inflammatory therapy.

Approach — Partial Overview

Management combines endoscopic esophageal dilation with effective anti-inflammatory medical or dietary elimination therapy. Dilation is carried out using a careful, incremental approach across one or more sessions — the complete technique, session parameters, and management algorithm are available in the full protocol.

Session-specific details, endpoint criteria, and the full sequencing are not shown here — access the complete protocol below.

Treatment Goals

The clinical target is a goal esophageal luminal diameter that relieves dysphagia and food impaction, achieved over one or more dilation sessions based on the initial caliber of the lumen.

References

DOI: 10.14309/ajg.0000000000003194

We suggest the use of endoscopic dilation as an adjunct to medical therapy as a treatment for esophageal strictures causing dysphagia in patients with EoE.
In a patient with dysphagia and esophageal stenosis or narrowing, dilation can be performed as discussed above.
In patients with fibrostenotic EoE, dilation therapy should occur in conjunction with effective medical or diet elimination anti-inflammatory therapy because dilation alone does not impact EoE disease activity.
In adult and adolescent patients with EoE, a goal luminal diameter that relieves dysphagia and food impaction (typically ≥16 mm) should be achieved over ≥1 sessions based on the initial caliber of the lumen and effect noted during dilation.
We advise a “start low and go slow” approach for esophageal dilation.

View source ↗

Treatment of Eosinophilic Esophagitis with Esophageal Stricture Causing Dysphagia

References