Esophageal Dilation

Esophageal dilation treats luminal narrowing from peptic strictures, anastomotic strictures, eosinophilic esophagitis, post-radiation injury, caustic ingestion, and Schatzki rings. The aim is durable symptomatic relief from dysphagia while minimizing perforation risk, which historically runs 0.1–0.4% per session and is higher in malignant or radiation-related strictures.

Two main dilator types are used. Bougies (Savary-Gilliard, Maloney) are tapered semi-rigid dilators advanced over a guidewire, providing longitudinal shear force as they cross the stricture. Through-the-scope balloons (Controlled Radial Expansion) deliver radial force at a fixed diameter and are ideal for short, complex, or angulated strictures and EoE. The "rule of threes" is a long-standing safety guideline — at any given session, take no more than three sequential dilator sizes once moderate resistance is encountered — though it is increasingly questioned for benign rings and Schatzki disease.

The BougieCap is a newer device combining a transparent cap fitted to the scope tip with progressive bougienage built in — offering direct visualization of the stricture during dilation and reducing reliance on fluoroscopy. Dilation alone is rarely durable for inflammatory strictures (EoE, peptic): adjunct therapy with PPIs, swallowed steroids, or anti-reflux surgery extends the dilation interval.