In patients with dysphagia and a normal esophagus on endoscopy, when is empiric dilation indicated?

This is somewhat controversial. There is some data that shows that some patients do experience improvement in swallowing following empiric esophageal dilation. This is more so the case in patients with solid food dysphagia, and when dilation does lead to some mucosal tearing. However, other studies have suggested that empiric dilation outcomes are comparable to placebo/control groups. In our practice, we often do empirically dilate because we know that as endoscopists, it can sometimes be difficult to detect very subtle narrowings/strictures endoscopically, and these may be "brought out" following dilation if a mucosal tear is seen. With that said, we know that different practices take different approaches toward this.