The impact of surgeon specialty and technique on outcomes after esophageal dilation: a systematic review.

To conduct a systematic review across four article databases to understand whether outcomes after esophageal dilation are affected by dilator type or physician specialty. Dilation of the upper esophagus is a commonly used technique to manage esophageal stenosis, which most commonly manifests as progressive dysphagia. Strictures arise from a multitude of etiologies; as such, they are treated by a variety of specialists, including otolaryngology, gastroenterology, and thoracic surgery. Dilations are commonly performed using either bougienage or balloon dilators, and there is a paucity of literature analyzing whether complications differ based on dilator type or physician specialty. A total of 3491 abstracts were initially screened using the Covidence reviewer platform. 433 full texts were assessed, and 15 studies met inclusion criteria. Four studies used balloon dilators, 8 studies used bougie dilators, and 3 studies used both techniques. When comparing adverse events between studies using either balloon or bougie dilators, half of each group (2/4 and 4/8) reported no perforations. Additional adverse outcomes, such as mediastinitis or bleeding, remained low with both bougie and balloon dilation; only one study reported mediastinitis as a complication, and only two studies reported significant postoperative bleeding (one bougie, one balloon). While technical success was heterogeneously defined, all studies reported significant improvement after dilation. While this study was limited by data heterogeneity, adverse outcomes after esophageal dilation remain low, regardless of dilation method or physician specialty.