Empiric esophageal dilatation for solid-food dysphagia: presence of mucosal tear on relook endoscopy predicts symptomatic response.

We hypothesized that a mucosal tear on relook endoscopy following empiric dilatation predicts symptomatic response. We evaluated symptomatic response (modified Ogilvie dysphagia score) following 161 consecutive esophageal dilatations. Comparing visible strictures, empiric dilatations with mucosal tear, and empiric dilatations without tear, baseline dysphagia scores were similar (p=0.34). Successful symptomatic response to dilatation occurred in 82% of visible strictures, 80% of those with tear, compared to only 37% of those with no tear (p<0.001). Patients with a mucosal tear following empiric dilatation have a superior symptomatic response to those without, and comparable to patients with visible strictures. We infer the tear represents disruption of an endoscopically inapparent stricture.