Effectiveness of Esophageal Dilation in Relieving Nonobstructive Esophageal Dysphagia and Improving Quality of Life

Abstract

Most patients with esophageal dysphagia have a nonobstructing esophageal lumen. Our prospective, randomized, controlled study does not support the practice of empiric esophageal dilation for patients with nonobstructive esophageal dysphagia. Improvement in both groups suggests the possibility that it occurred due to proton pump inhibitor therapy, lending credence to the hypothesis that esophageal hypersensitivity to acid contributes to symptoms in most patients with nonobstructive esophageal dysphagia, which is the predominant category of dysphagia.

Empiric Dilation in Non-obstructive Dysphagia

“…13 Lavu et al reported that 67% of all esophageal dilations at an academic institution were performed to treat nonobstructive dysphagia. 11 Our study revealed similarly that esophageal dilation was more commonly used for treatment of non-obstructive dysphagia than peptic strictures. This finding is surprising, considering that esophageal dilation is universally accepted as the firstline therapy for benign strictures, whereas its role in non-obstructive dysphagia has remained controversial.…”

“…The study by Lavu et al examined not only the effect of 56-French empiric dilation on dysphagia but also diet scores and quality of life. 11 The investigators found no difference between the outcome scores of the 17 study and 13 control patients. The authors argued that since both, study and control group, improved to equal degree, the results might reflect the beneficial effects of proton pump inhibitors, on which both the groups were placed, highlighting the possibility of involvement of visceral hypersensitivity in the pathogenesis in non-obstructive dysphagia.…”

“…8 Three subsequent randomized trials, however, found little or no benefit associated with empiric dilation. [9][10][11] Based on the outcomes of these trials, the most recent guidelines of the American Society for Gastrointestinal Endoscopy (ASGE) from 2006 no longer advocate empiric dilation. 12 Although empiric dilation for non-obstructive dysphagia is rather common in gastroenterological practice, 11,13 there have been no large-scale studies to delineate the practice patterns of its use, and no study has evaluated the rate of recurrent dilations following the initial therapy.…”

Endoscopic Dilation of Benign and Malignant Esophageal Strictures

“…1). Currently, malignant disorders, post-anastomotic or radiation-induced stenosis constitute common causes of esophageal strictures [1,[3][4][5][6] ( fig. 2, 3).…”

“…The main indication for esophageal dilation is to relieve benign or malignant dysphagia [2][3][4][5]. Endoscopic dilation of malignant strictures is also performed to facilitate the completion of endoscopic procedures, such as endoscopic ultrasonographic tumor staging, to permit the placement of esophageal stents or to place a percutaneous endoscopic gastrostomy for feeding purposes [6][7][8].…”