ESOPHAGEAL DILATATION

Esophageal dilatation as a treatment option in patients with both beni gn and malignant esophageal strictures is described. Types of dilators available, techniques of passage, complications, redilation rates, an d comparative studies between dilating systems are reviewed. The use o f proton pump inhibitors to reduce the rates of redilation is discusse d in view of the natural history of benign esophageal strictures. Comp arisons among blind passage, fluoroscopic guidance and endoscopically directed dilatation are made and discussed in relation to cost effecti veness. Brief mention of new dilating systems including wall stents an d wall-tension-sensing systems are made. Achalasia treatment with pneu matic dilatation is described in detail and compared to medication and surgical myotomy options. New treatments, including botulinum toxin i njection into the lower esophageal sphincter, are briefly mentioned.