The short- and long-term efficacy of empirical esophageal dilation in patients with nonobstructive dysphagia: a prospective, randomized study.

Abstract

The efficacy of empirical esophageal dilation for nonobstructive dysphagia (NOD) is unknown. Our aim was to assess the efficacy and safety of empirical dilation with a large bougie in patients with NOD. Patients with NOD (normal barium swallow, free passage of a 13-mm barium pill, and normal esophagogastroduodenoscopy) were randomized to dilation with either a 50-Fr (Group A) or 26-Fr (Group B) Maloney dilator. Before dilation, the dysphagia (DyspSC) and diet (DietSc) scores were recorded and an esophageal manometry performed. Both scores were reassessed at 1, 3, 7, and 14 days after dilation. Success was defined at day 14 as an improvement in the DietSc of at least 25% from baseline, or a DyspSc of < or =3. Nonresponders were crossed-over to the alternate dilator and restudied. Twenty-three patients (58.7+/-1.9 yr) were enrolled: 13 in Group A and 10 in Group B. Both groups were matched for age, baseline DyspSc (4.2+/-0.6 vs 3.8+/-0.5), baseline DietSc (13.3+/-1.7 vs 12.0+/-1.9), and manometric findings. A nonspecific motility disorder was seen in 43.4% patients. Group A had an initial response rate significantly greater (84.6%) than Group B (40%) (p = 0.03; odds ratio [OR] = 8.25). The DyspSc and DietSc were better than baseline with both dilators, but only the DietSc improved significantly in patients dilated with the 50-Fr dilator (5.3+/-1.9 vs 12.3+/-1.4; p = 0.004). At 2 yr, 80% of the patients responding to the 50-Fr Maloney had a sustained response. Empirical dilation with a large (50-Fr) bougie is safe, effective, and long-lasting in improving nonobstructive dysphagia.