Table 11.

Summary of Findings for PICO Question 8^a

Esophageal dilation compared to no dilation for EoE
Outcomes	No. of participants (studies), follow-up89	Certainty of the evidence (GRADE)	Relative effect, RR (95% CI)	Anticipated absolute effects
				Risk with no dilatation	Risk difference with esophageal dilation
Clinical improvement (not defined)b,c	1928 dilations (14 observational studies)d	⊕◯◯◯ VERY LOWe,f,g	Not estimable	0 per 100h	0 fewer per 100 (0 fewer to 0 fewer)
Mortalityi	2772 dilations (20 observational studies)i	⊕◯◯◯ VERY LOWe,g	Not estimable	—h	—
Perforationi	2772 dilations (20 observational studies)j	⊕◯◯◯ VERY LOWe,g	Not estimable	0 per 1000h	0 fewer per 1000 (0 fewer to 0 fewer)
Hospitalizationi	2466 dilations (12 observational studies)k	⊕◯◯◯ VERY LOWe,g	Not estimable	0 per 1000h	0 fewer per 1000 (0 fewer to 0 fewer)
Hemorrhagei,l	2588 dilations (12 observational studies)	⊕◯◯◯ VERY LOWe,g	Not estimable	0 per 1000h	0 fewer per 1000 (0 fewer to 0 fewer)

^aThe risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

^bFollow-up median of 12 mo and a range from 1 wk to 36 mo.

^cClinical improvement expressed per patient. Heterogeneous definition of “clinical improvement.”

^d37 studies were included in meta-analysis, though only 14 studies were included for this outcome. There was 1 randomized trial (Kavitt) and the rest were observational studies with more than 5 participants. Some studies did not specify the number of participants and were excluded. The included case-control (Cohen et al) study in the Dougherty meta-analysis was also excluded in this analysis.

^eAbsolute rate calculated from data provided in Dougherty et al meta-analysis, pooling data from cohort/RCT studies where “n” was available for outcome of interest. Case-control and observational studies will <5 patients were excluded. Only absolute rates provided because there was no control group.

^fDespite heterogeneity of pooled estimate, assumption is that dilation does cause symptomatic improvement.

^gIt was noted that patients who need dilation have fibrostenotic disease. Though this population may be distinct from those included in studies where therapeutic management with medications was investigated, we did not rate down for indirectness.

^hAssumption was that no clinical improvement or adverse events could occur if dilation not performed.

ⁱExpressed as number per dilation.

^j37 studies were included in meta-analysis, though only 20 studies were included for this outcome. There was one randomized trial (Kavitt) and there rest were observational studies with more than 5 participants. Some studies did not specify the number of participants, and as such, were excluded. The included case-control (Cohen et al) study in the Dougherty meta-analysis was also excluded in this analysis.

^k37 studies were included in meta-analysis, though only 12 studies were included for this outcome. There was one randomized trial (Kavitt) and the rest were observational studies with more than 5 participants. Some studies did not specify the number of participants, and as such, were excluded. The included case-control (Cohen et al) study in the Dougherty meta analysis was also excluded in this analysis.

^lSignificant gastrointestinal bleeds were those defined as needing additional clinical intervention, usually re-endoscopy, and did not include mucosal tears seen immediately after dilation.