Empiric Esophageal Dilation Is Not Useful for Nonobstructive Dysphagia

Empiric Esophageal Dilation Is Not Useful for Nonobstructive Dysphagia

Prateek Sharma, MD, FASGE, reviewing Kamal F, et al. Scand J Gastroenterol 2021 Dec.

Empiric esophageal dilation often is performed for patients presenting with dysphagia who have no evidence of an anatomic obstruction or lesion. However, there is little evidence that the procedure is effective in the management of nonobstructive dysphagia. 

This systematic review and meta-analysis included observational and randomized controlled trials (RCTs) that compared empiric dilation to a sham procedure or medical treatment. The primary outcomes of interest were clinical success (improvement in the dysphagia score after dilation) and the results of a comparison of the posttherapy dysphagia score between the 2 groups. 

Of 107 initial articles identified, only 4 studies (3 RCTs, 1 observational) were included (243 patients: 133 received dilation and 110 were controls). There was no significant difference in clinical scores between the dilation and control groups (75% vs 63%, respectively; odds ratio [OR], 1.91; 95% confidence interval [CI], 0.89-4.08; I2=23%). The results were similar when the observational study was excluded (OR, 2.99; 95% CI, 0.63-14.05; I2=49%). Furthermore, there was no significant difference in dysphagia scores between the dilation and control groups after intervention (standardized mean difference, 0.38; 95% CI, −0.37 to 1.14; I2=73%).

Prateek Sharma, MD, FASGE


In patients with nonobstructive dysphagia, improvement in dysphagia scores was no different between empiric dilation and controls. Given these findings, empiric esophageal dilation for nonobstructive dysphagia does not appear to be useful.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Kamal F, Khan MA, Lee-Smith W, et al. Efficacy of empiric esophageal dilation in patients with non-obstructive dysphagia: systematic review and meta-analysis. Scand J Gastroenterol 2021;56:1490-1495. (https://doi.org/10.1080/00365521.2021.1971288)

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