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.
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05/01/2026
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by Gyanprakash A. Ketwaroo, MD, MSc , William J. Ravich, MD , Aylin Tansel, MD , Yamini Natarajan, MD
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1
Accurate diagnosis and effective management of upper gastrointestinal disorders are crucial for patient relief.
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Barium esophagram remains essential for diagnosing dysphagia, contrary to some guidelines suggesting its obsolescence.
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3
The 'Rule of Three' in esophageal dilation has ambiguities and may not significantly increase perforation risk when not followed.
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4
Dilation aims to alleviate symptoms, with a target luminal diameter of 18-20 mm based on Schatzki's findings.
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Recurrent dysphagia occurs in about 50% of patients after dilation, necessitating potential repeat procedures.