Empiric Dilation in Non-obstructive Dysphagia

Aims: To study practice patterns in the management of non-obstructive dysphagia among U.S. gastroenterologists.

Data Source: Endoscopic data repository from 100 U.S. gastroenterology practices during 1998-2003 (Clinical Outcomes Research Initiative, CORI).

Methods: All initial esophago-gastro-duodenoscopies (EGDs) performed in adult patients between 1998 and 2003 (n = 181,261) were evaluated for demographic data, endoscopic findings, and the occurrence of esophageal dilation. A case population of 7,256 patients receiving empiric dilation for dysphagia for non-obstructive dysphagia was compared to a control population of 5764 patients with dilation for peptic strictures.

Results: The group of patients with empiric dilation was younger than the group of patients with peptic strictures and contained more women. Reflux symptoms and erosive esophagitis were less frequent in the empiric dilation group than in the strictures group. Empiric dilations were mostly performed using rubber bougies, whereas strictures were most frequently dilated over a guidewire. For all types of dilators, the diameters were significantly larger in empiric than stricture dilation. Repeat dilations within 1 year after the initial procedure occurred in 4% of the empiric and 13% of the stricture dilations.

Conclusions: Compared with the dilation of peptic strictures, empiric dilation of non-obstructive dysphagia is a more common clinical practice that is performed in a different patient population and utilizes different techniques.