Empiric Esophageal Dilation Is Not Useful for Nonobstructive Dysphagia

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%).