S1073 Optimizing Dysphagia Management: The Role of Manometry and Dilator Size in Empiric Esophageal Dilation

Introduction: Empiric esophageal dilation (EED) is frequently employed for nonobstructive dysphagia (NOD), yet the influence of procedural factors such as manometry utilization and dilator size on clinical outcomes remains unclear. This study evaluates their impact to inform best practices. Methods: We retrospectively reviewed 83 patients who underwent EED for NOD. Symptom severity was assessed using the NIH PROMIS-GI dysphagia scale at baseline and post-dilation. Patients were stratified based on whether pre-procedural manometry was performed and by dilator size (small: 16-17 mm; medium: 18-19 mm; large: ≥20 mm). T-tests, ANOVA, and logistic regression were used to assess predictors of symptom improvement and complication rates. Results: Among the cohort, 21 patients (25.3%) underwent manometry prior to EED, while 62 (74.7%) did not. Dysphagia improvement was noted in 47.6% of patients with manometry versus 62.9% without (P = 0.223). Improvement varied significantly by dilator size: 78.6% with small, 57.8% with medium, and 25.0% with large dilators (P = 0.04). Complications included mucosal tears (31.3%) and bleeding (14.5%), with no significant association to manometry or dilator size. Conclusion: In this single-center study, smaller dilators were associated with significantly higher symptom improvement in patients undergoing EED for NOD. Pre-procedural manometry did not significantly influence outcomes. These findings support a tailored procedural approach, particularly the use of smaller dilators, in optimizing dysphagia management. Prospective studies are needed to confirm these results and inform guidelines.