Summary Background Oesophageal dilation is frequently used as an adjunct treatment to alleviate symptoms that develop from fibrostenotic remodelling in eosinophilic oesophagitis (EoE). Earlier reports described an increased risk of complications associated with dilation. Aim Perform a systematic review and meta‐analysis to assess the efficacy and safety of endoscopic dilation in children and adults with EoE. Methods Professional librarians searched MEDLINE, EMBASE, the Cochrane library, Scopus, and Web of Science for articles in any language describing studies of dilation in EoE through December 2016. Studies were selected and data were ed independently and in duplicate. Random effects modelling was used to generate summary estimates for clinical improvement and complications (haemorrhage, perforation, hospitalisation, and death). Results The search resulted in 3495 references, of which 27 studies were included in the final analysis. The studies described 845 EoE patients, including 87 paediatric patients, who underwent a total of 1820 oesophageal dilations. The median number of dilations was 3 (range: 1‐35). Clinical improvement occurred in 95% of patients (95% CI: 90%‐98%, I2: 10%, 17 studies). Perforation occurred in 0.38% (95% CI: 0.18%‐0.85%, I2: 0%, 27 studies), haemorrhage in 0.05% (95% CI: 0%‐0.3%, I2: 0%, 18 studies), and hospitalisation in 0.67% (95% CI: 0.3%‐1.1%, I2: 44%, 24 studies). No deaths occurred (95% CI: 0%‐0.2% I2: 0%, 25 studies). Conclusions Endoscopic dilation is consistently effective in children and adults with EoE, resulting in improvement in 95% of patients with very low rates (<1%) of major complications. Linked ContentThis article is linked to Moaward et al and Kia and Hirano papers. To view these articles visit https://doi.org/10.1111/apt.14216 and https://doi.org/10.1111/apt.14213.