Utility of Esophageal Dilatation in EoE

Esophageal dilation addresses the fibrostenotic component of EoE, which results from longstanding inflammation leading to scarring, rings, and strictures that cannot be resolved through anti-inflammatory treatments alone. This mechanical intervention becomes necessary when structural narrowing causes persistent dysphagia despite adequate inflammatory control. Clinicians maintain a low threshold for dilation in patients with ongoing swallowing difficulties, as subtle strictures can be easily missed during routine endoscopy.

Technical approaches include balloon dilation and wire-guided bougie techniques, with selection based on stricture characteristics. Focal distal strictures may be treated with through-the-scope balloons, while multifocal narrowings throughout the esophageal length may benefit from Savary dilators that provide both radial and longitudinal shearing forces. The balloon pull-through technique allows comprehensive evaluation of the entire esophageal caliber while enabling targeted treatment of identified narrowed areas. Practitioners emphasize achieving visible mucosal disruption or “dilation effect” as evidence of therapeutic intervention, though this requires careful patient communication using appropriate terminology.

Safety considerations and technique refinements distinguish EoE dilation from peptic stricture treatment. EoE tissue tends to tear more readily, necessitating gradual, conservative approaches rather than aggressive dilation. Optimal timing involves treating inflammatory disease first, as dilating inflamed tissue increases postprocedural discomfort and complications. Pediatric applications require additional considerations, including family education and diagnostic aids such as esophagrams or EndoFLIP technology to identify subtle strictures not apparent on visual inspection. These tools help detect narrowings present in up to half of cases where visual assessment appears normal, enabling informed discussions with families about intervention necessity. The procedure is routinely performed during adult endoscopy but requires more deliberate planning in pediatric populations, emphasizing the importance of comprehensive esophageal evaluation before biopsy collection to identify all areas requiring therapeutic intervention.