Esophageal care, reexamined: Dilation, dysmotility, and diagnostic debates

Practical guidance on esophageal dilation, the evolving role of the esophagram, and a phenotype-based approach to managing dysmotility.

05/01/2026

by Gyanprakash A. Ketwaroo, MD, MSc , William J. Ravich, MD , Aylin Tansel, MD , Yamini Natarajan, MD

Objective:

To provide insights on esophageal dilation techniques and the management of upper gastrointestinal disorders, particularly dysphagia and dysmotility, emphasizing the need for tailored approaches.

Key Findings:

High-quality barium esophagram is crucial for accurate dysphagia diagnosis and should be prioritized in initial evaluations.
The 'Rule of Three' in dilation lacks clear guidelines and may not significantly increase perforation risk, suggesting flexibility in practice.
Dilation is effective for Schatzki’s rings, but recurrent dysphagia occurs in about 50% of cases, indicating the need for ongoing management.

Interpretation:

The article emphasizes the need for tailored diagnostic and therapeutic approaches in esophageal care, particularly in managing dysphagia and dysmotility disorders, and suggests areas for future research.

Limitations:

The article does not provide extensive data on long-term outcomes of dilation, which could inform best practices.
Potential biases in retrospective studies on dilation practices are not addressed, which may affect the reliability of findings.

Conclusion:

A nuanced understanding of esophageal dilation and diagnostic techniques can enhance clinical practice and patient outcomes in upper GI disorders, underscoring the importance of ongoing research.