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

OBJECTIVE: 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. METHODS: Patients with NOD (normal barium swallow, free passage of a 13-mm barium pill, and normal esophagogastroduodenoscopy) were randomized to dila tion with either a 50-Fr (Group A) or 26-Fr (Group B) Maloney dilator. Befo re 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 improv ement in the DietSc of at least 25% from baseline, or a DyspSc of less than or equal to 3. Nonresponders were crossed-over to the alternate dilator an d restudied. RESULTS: 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 Diet Sc were better than baseline with both dilators, but only the DietSc improv ed 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. CONCLUSION: Empirical dilation with a large (50-Fr) bougie is safe, effecti ve, and long-lasting in improving nonobstructive dysphagia. (C) 2000 by Am. Cell. of Gastroenterology.