Eosinophilic Esophagitis: Analysis of Food Impaction and Perforation in 251 Adolescent and Adult Patients

doi:10.1016/j.cgh.2008.02.003

Clinical Gastroenterology and Hepatology

Volume 6, Issue 5, May 2008, Pages 598-600

https://doi.org/10.1016/j.cgh.2008.02.003 Get rights and content

Background & Aims: Eosinophilic esophagitis is a rapidly emerging, chronic inflammatory disorder. Prolonged inflammation evokes structural alterations and a fragile esophageal wall prone to perforation/rupture and food impaction. This report assesses the risk of spontaneously arising and procedure-induced complications and proposes practical recommendations. Methods: The Swiss Esophageal Esophagitis Database documented 251 confirmed cases. A chart review identified which patients had required endoscopic bolus removal and/or experienced transmural esophageal perforation/rupture. In addition, a MEDLINE search for “eosinophilic esophagitis” with “esophageal perforation” or “esophageal rupture” was undertaken. Results: During an 18-year period, 87 patients (34.7%) experienced 134 food impactions requiring flexible (124, 92.5%) or rigid (10, 7.5%) endoscopic bolus removal. Transmural perforation occurred in 20% (2/10) of rigid procedures, and 1 esophageal rupture (Boerhaave's syndrome) was observed. Conclusions: Bolus removal by rigid endoscopy is a high-risk procedure and should be avoided in eosinophilic esophagitis patients who require a gentler approach. Whether food impaction and esophageal wall remodeling can be prevented with anti-inflammatory medication is still undetermined. All Boerhaave's syndrome cases should be evaluated for underlying eosinophilic esophagitis.

Section snippets

Methods

The Swiss EE Study Group consecutively enrolls patients presenting with a confirmed (by using clinical, endoscopic, and histologic methods) diagnosis into a Swiss EE Database, SEED, which was nationally established in 1989. Inclusion criteria are (1) PPI-resistant esophageal-related symptoms, (2) EE-consistent endoscopic abnormalities, (3) infiltration of the esophageal mucosa with at least 24 eosinophils/high-power field (HPF), and (4) informed consent.

We performed a chart review and included

Results and Case Presentation

The SEED documents a total of 251 confirmed EE cases in adults and adolescents. During this 18-year period, 87 patients (34.7%) experienced 1 or more (range, 1–5) persistent food impactions requiring endoscopic bolus removal. A total of 134 emergency endoscopies were undertaken to remove impacted food. Of these, 124 (92.5%) were performed with flexible gastrointestinal (GI) endoscopy under sedation and 10 (7.5%) by rigid ENT endoscopy under general anesthesia. The selection of the procedure

Discussion and Conclusions

We report here on our 18-year experience with food impaction and esophageal perforation in 251 EE patients. In addition, we present 2 EE patients in whom the esophageal perforation was procedure-induced and 1 case in which rupture was associated with Boerhaave's syndrome. The management of persistent food impaction with the potentially fatal complication of an esophageal breach has several important clinical and legal consequences.

Food impaction is a common complication in EE patients.⁵ More

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Eosinophilic esophagitis (EoE) is an immune-mediated esophageal disease characterized by symptoms related to esophageal dysfunction and eosinophil-predominant inflammation. The aims of our study included (1) to assess esophageal motility patterns of EoE by topographic analysis of high-resolution manometry (HRM) and (2) to establish a relationship between symptoms of EoE and motility abnormalities seen on HRM.
A retrospective study in which all adult patients over 18 years of age with EoE diagnosed by endoscopy and histology and who underwent HRM were included in the study during the study period. Motility patterns in patients with EoE under HRM were analyzed. Data were presented as frequencies and percentages with inference by Pearson’s chi-square test or Fisher’s exact test.
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The BougieCap (Ovesco Endoscopy AG, Tübingen, Germany) is a new device that allows optical and tactile feedback during stricture dilation of the upper GI tract. We evaluated the technical feasibility, clinical efficacy, and safety of a 1-time esophageal stricture dilation using the BougieCap in adults with eosinophilic esophagitis (EoE).
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In adults with EoE, endoscopic treatment of esophageal strictures using the BougieCap is technically feasible and safe and offers significant symptomatic improvement in the short term.

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Brief communicationEosinophilic Esophagitis: Analysis of Food Impaction and Perforation in 251 Adolescent and Adult Patients

Section snippets

Methods

Results and Case Presentation

Discussion and Conclusions

Gastroenterology

J Allergy Clin Immunol

Gastrointest Endosc

Gastrointest Endosc

Gastroenterology

J Allergy Clin Immunol

Clin Gastroenterol Hepatol

Brief communication
Eosinophilic Esophagitis: Analysis of Food Impaction and Perforation in 251 Adolescent and Adult Patients