{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T20:54:58Z","timestamp":1788900898048,"version":"build-2803163510"},"reference-count":35,"publisher":"Georg Thieme Verlag KG","issue":"03","funder":[{"DOI":"10.13039\/100009560","name":"American Gastroenterological Association","doi-asserted-by":"crossref","award":["Research Scholar Award"],"award-info":[{"award-number":["Research Scholar Award"]}],"id":[{"id":"10.13039\/100009560","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["R01 DK101856,T32 DK007634,T35 DK007386"],"award-info":[{"award-number":["R01 DK101856,T32 DK007634,T35 DK007386"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2002Little is known about esophageal dilation as a long-term treatment approach for eosinophilic esophagitis (EoE). We examined the impact of a \u201cdilate and wait\u201d strategy on symptom management and safety of patients with EoE.<\/jats:p><jats:p>\n          Methods\u2002This retrospective cohort study included two patient groups: those who underwent a dilation-predominant approach (\u2265\u200a3 dilations as sole therapy or for histologically refractory disease [&gt;\u200a15 eos\/hpf]); and those who had routine care (&lt;\u200a3 dilations or histologic response). Group characteristics were compared and outcomes for the dilation-only group assessed.<\/jats:p><jats:p>\n          Results\u200253\/205 patients (26\u200a%) received the dilation-predominant strategy (total 408 dilations), predominantly for histologic treatment nonresponse (75\u200a%). These patients were younger (33 vs. 41 years; P\u200a=\u200a0.003), had a narrower baseline esophageal diameter (9.8 vs. 11.5 mm; P\u200a=\u200a0.005), underwent more dilations (7.7 vs. 3.4; P\u200a&lt;\u200a0.001), but achieved a smaller final diameter (15.7 vs. 16.7 mm; P\u200a=\u200a0.01) vs. routine care. With this strategy, 30 patients (57\u200a%) had ongoing symptom improvement, with esophageal caliber change independently associated with symptom response (adjusted odds ratio 1.79, 95\u200a% confidence interval 1.16\u20132.78); 26 (49\u200a%) used the strategy as a bridge to clinical trials. Over a median follow-up of 1001 days (interquartile range 581\u20131710), no deaths or dilation-related perforations occurred, but there were nine emergency room visits, including one for post-dilation bleeding and four for food impaction.<\/jats:p><jats:p>\n          Conclusions\u2002A dilation-predominant long-term treatment strategy allowed for symptom control or bridge to clinical trials for patients with difficult-to-treat EoE. Close follow-up and monitoring for complications are required.<\/jats:p>","DOI":"10.1055\/a-1493-5627","type":"journal-article","created":{"date-parts":[[2021,4,28]],"date-time":"2021-04-28T23:12:56Z","timestamp":1619651576000},"page":"243-250","source":"Crossref","is-referenced-by-count":21,"title":["Dilation-predominant approach versus routine care in patients with difficult-to-treat eosinophilic esophagitis: a retrospective comparison"],"prefix":"10.1055","volume":"54","author":[{"given":"Sydney","family":"Greenberg","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole C.","family":"Chang","sequence":"additional","affiliation":[{"name":"School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Ryanne","family":"Corder","sequence":"additional","affiliation":[{"name":"School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig C.","family":"Reed","sequence":"additional","affiliation":[{"name":"Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States"},{"name":"Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swathi","family":"Eluri","sequence":"additional","affiliation":[{"name":"Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States"},{"name":"Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1167-1101","authenticated-orcid":false,"given":"Evan S.","family":"Dellon","sequence":"additional","affiliation":[{"name":"Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States"},{"name":"Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2021,6,10]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"1238","DOI":"10.1053\/j.gastro.2014.07.055","article-title":"Advances in clinical management of eosinophilic esophagitis","volume":"147","author":"E S Dellon","year":"2014","journal-title":"Gastroenterology"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1053\/j.gastro.2018.07.009","article-title":"Updated international consensus diagnostic criteria for eosinophilic esophagitis: proceedings of the AGREE conference","volume":"155","author":"E S Dellon","year":"2018","journal-title":"Gastroenterology"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1053\/j.gastro.2017.06.067","article-title":"Epidemiology and natural history of eosinophilic esophagitis","volume":"154","author":"E S Dellon","year":"2018","journal-title":"Gastroenterology"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1016\/j.cgh.2008.02.003","article-title":"Eosinophilic esophagitis: analysis of food impaction and perforation in 251 adolescent and adult patients","volume":"6","author":"A Straumann","year":"2008","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/j.gie.2013.10.027","article-title":"A phenotypic analysis shows that eosinophilic esophagitis is a progressive fibrostenotic disease","volume":"79","author":"E S Dellon","year":"2014","journal-title":"Gastrointest Endosc"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/j.gtc.2014.02.015","article-title":"Clinical implications and pathogenesis of esophageal remodeling in eosinophilic esophagitis","volume":"43","author":"I Hirano","year":"2014","journal-title":"Gastroenterol Clin N 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Gastroenterol"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1016\/j.gie.2017.04.028","article-title":"Esophageal dilation with either bougie or balloon technique as a treatment for eosinophilic esophagitis: a systematic review and meta-analysis","volume":"86","author":"M Dougherty","year":"2017","journal-title":"Gastrointest Endosc"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1097\/MEG.0000000000000103","article-title":"The safety of a strict wire-guided dilation protocol for eosinophilic esophagitis","volume":"26","author":"S Saligram","year":"2014","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1038\/ajg.2009.657","article-title":"Esophageal dilation in eosinophilic esophagitis: effectiveness, safety, and impact on the underlying inflammation","volume":"105","author":"A M Schoepfer","year":"2010","journal-title":"Am J Gastroenterol"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1038\/ajg.2015.433","article-title":"Eosinophilic esophagitis dilation in the community \u2013 try it \u2013 you will like it \u2013 but start low and go slow","volume":"111","author":"J E Richter","year":"2016","journal-title":"Am J Gastroenterol"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/dote\/dox042","article-title":"Control of inflammation decreases the need for subsequent esophageal dilation in patients with eosinophilic esophagitis","volume":"30","author":"T M Runge","year":"2017","journal-title":"Dis Esophagus"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1055\/s-0042-107340","article-title":"Severity of endoscopically identified esophageal rings correlates with reduced esophageal distensibility in eosinophilic esophagitis","volume":"48","author":"J W Chen","year":"2016","journal-title":"Endoscopy"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1016\/j.gie.2014.02.012","article-title":"The natural history of steroid-na\u00efve eosinophilic esophagitis in adults treated with endoscopic dilation and proton pump inhibitor therapy over a mean duration of nearly 14 years","volume":"80","author":"S Lipka","year":"2014","journal-title":"Gastrointest Endosc"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"1667","DOI":"10.1016\/j.cgh.2018.01.028","article-title":"Prolonged time to diagnosis of eosinophilic esophagitis despite increasing knowledge of the disease","volume":"16","author":"C C Reed","year":"2018","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1055\/a-1284-5891","article-title":"Clinical features and time trends associated with an endoscopically normal esophagus in active eosinophilic esophagitis","author":"S Eluri","year":"2020","journal-title":"Endoscopy"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1038\/ajg.2016.515","article-title":"How I approach the management of eosinophilic esophagitis in adults","volume":"112","author":"I Hirano","year":"2017","journal-title":"Am J Gastroenterol"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/j.cgh.2017.09.046","article-title":"Optimal histologic cutpoints for treatment response in patients with eosinophilic esophagitis: analysis of data from a prospective cohort study","volume":"16","author":"C C Reed","year":"2018","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1111\/apt.14290","article-title":"Food elimination diets are effective for long-term treatment of adults with eosinophilic oesophagitis","volume":"46","author":"C C Reed","year":"2017","journal-title":"Aliment Pharmacol Ther"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"2800","DOI":"10.1016\/j.cgh.2019.03.009","article-title":"Combination therapy with elimination diet and corticosteroids is effective for adults with eosinophilic esophagitis","volume":"17","author":"C C Reed","year":"2019","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s00535-017-1397-z","article-title":"The role of maintenance therapy in eosinophilic esophagitis: who, why, and how?","volume":"53","author":"H Philpott","year":"2018","journal-title":"J Gastroenterol"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.jaci.2019.10.027","article-title":"Emerging therapies for eosinophilic esophagitis","volume":"145","author":"T Greuter","year":"2020","journal-title":"J Allergy Clin Immunol"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1038\/nrgastro.2017.56","article-title":"Management of refractory eosinophilic oesophagitis","volume":"14","author":"E S Dellon","year":"2017","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"2408","DOI":"10.1007\/s10620-017-4642-7","article-title":"Six-food elimination diet and topical steroids are effective for eosinophilic esophagitis: a meta-regression","volume":"62","author":"C C Cotton","year":"2017","journal-title":"Dig Dis Sci"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"1660","DOI":"10.1053\/j.gastro.2003.09.024","article-title":"Natural history of primary eosinophilic esophagitis: a follow-up of 30 adult patients for up to 11.5 years","volume":"125","author":"A Straumann","year":"2003","journal-title":"Gastroenterology"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1097\/MCG.0000000000000297","article-title":"Impact of diagnostic delay and other risk factors on eosinophilic esophagitis phenotype and esophageal diameter","volume":"50","author":"S Lipka","year":"2016","journal-title":"J Clin Gastroenterol"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.gie.2020.01.015","article-title":"Clinical outcomes of adults with eosinophilic esophagitis with severe stricture","volume":"92","author":"J P Kim","year":"2020","journal-title":"Gastrointest Endosc"}],"container-title":["Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-1493-5627.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,10]],"date-time":"2022-08-10T09:54:19Z","timestamp":1660125259000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-1493-5627"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,28]]},"references-count":35,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2022,2,24]]},"published-print":{"date-parts":[[2022,3]]}},"URL":"https:\/\/doi.org\/10.1055\/a-1493-5627","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0013-726X","1438-8812"],"issn-type":[{"value":"0013-726X","type":"print"},{"value":"1438-8812","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,4,28]]},"published":{"date-parts":[[2021,4,28]]}}}