Esophageal dilatation

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