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Aim This study is aimed to assess the safety of esophageal dilation (ED) in a large cohort of eosinophilic esophagitis (EoE) cases in a single center. Background & Method EoE, the leading cause of food impaction, is a chronic immune-mediated disorder characterized by esophageal dysfunction and mucosal eosinophilic infiltration (≥ 15 eos/hpf). ED is considered a second-line therapy for EoE after failure of medication, due to concern of perforation. We performed a retrospective review of EoE patients who received ED at University of Iowa Hospitals and Clinics from 2006 to 2018. ED types, complications, and symptomatic improvement were extracted via chart review. Descriptive statistic with univariate analysis was performed. Results Of 1050 EoE patients, 160 received 295 EDs, ranging from 1-12 dilations per patient, with 67 patients requiring >1 dilations. Procedures were generally well-tolerated, without major bleeds or perforations. The overall complication rate was 6.1%, mostly post-procedural chest pain (4.8%). Three patients had sedation-related complications: one aspiration pneumonia and two ICU admissions for respiratory distress. Symptomatic improvement was documented in 87% of dilations on follow up. Conclusion EoE prevalence is increasing with rates of 1 cases per 1000 individuals, with up to one-third requiring ED for symptomatic relief. Previous reports suggested an increased procedure-related risk, mainly esophageal perforation. However, recent systematic reviews have shown low perforation rate of