Large caliber empiric esophageal dilation results in sustained improvement for selected patients with non-obstructive dysphagia

Introduction:

Empiric esophageal dilation (EED) remains a controversial practice for managing non-obstructive dysphagia (NOD) secondary to concerns about safety and efficacy. Here, we examine symptom response, presence of tissue disruption, and adverse events (AEs) after EED.

Methods:

We examined large caliber bougie EED for NOD at two tertiary referral centers: retrospectively evaluating for AEs. Esophageal manometry diagnoses were also reviewed. We then prospectively assessed EED’s efficacy using the NIH Patient-Reported Outcomes Measurement Information System (PROMIS) disrupted swallowing questionnaire to assess dysphagia at baseline, 1-, 3-, and 6-months after EED. Treatment success was defined by improvement in patient reported outcome score.

Results:

AE rate for large caliber dilation in the retrospective cohort of 180 patients undergoing EED for NOD was low (0.5% perforations, managed conservatively). Visible tissue disruption occurred in 18% of patients, with 47% occurring in the proximal esophagus. Obstructive motility disorders were found more frequently in patients with tissue disruption compared to those without (44% vs 14%, p=0.05).

The primary outcome, the mean disrupted swallowing T-score was 60.1 ± 9.1 at baseline, 56.1 ± 9.5 at 1-month (p=0.03), 57 ± 9.6 at 3-months (p=0.10), and 56 ± 10, 6-months (p=0.02), (higher scores note more symptoms). EED resulted in a significant and durable improvement in dysphagia, and specifically solid food dysphagia among patients with tissue disruption.

Discussion:

EED is safe in solid food NOD and particularly effective when tissue disruption occurs. EED tissue disruption in NOD does not preclude esophageal dysmotility.