Does empiric esophageal dilation benefit dysphagia when endoscopy is normal?

Some patients referred for esophagogastroduodenoscopy (EGD) to evaluate symptoms of dysphagia have normal endoscopies. How best to manage these patients is unclear. We reviewed our experience with empiric esophageal dilation in this setting. Over a five-year period, 40 consecutive patients with esophageal dysphagia and normal EGD underwent empiric esophageal dilation at the time of their endoscopy. Postdilation follow-up was available in 37 of the 40. The patients were divided into two groups depending on whether their dysphagia was to solid food only or to both solids and liquids. The two groups were comparable as regards age, sex, and the frequency of heartburn. Complete resolution of dysphagia was seen in 19 of 20 patients (95%) with solid-food-only dysphagia. In contrast, only two of 17 patients (12%) with solid and liquid dysphagia had complete resolution with empiric dilation, although another six patients (35%) had partial improvement. The difference in response between the two groups was highly significant (P < 0.0001). The response to dilation in patients with dysphagia to solid food only was often long-lasting. Most patients with dysphagia to solid food only and a normal EGD benefit from empiric esophageal dilation performed at the time of their endoscopy. In contrast, few patients with dysphagia to both solids and liquids respond.