Esophageal dilation is a medical intervention designed to widen the esophagus, which is the muscular tube connecting the throat to the stomach. This procedure is performed when the esophagus narrows, which makes swallowing difficult and can compromise nutrition. The goal of dilation is to restore the normal passageway for food and liquid. It is a specialized medical procedure always performed by a gastroenterologist.
Understanding Esophageal Dilation
The goal of esophageal dilation is to stretch and tear the scar tissue or material causing the narrowing, thereby improving dysphagia, or difficulty swallowing. Gastroenterologists use two primary methods: bougie dilation and balloon dilation. The choice depends on the specific characteristics and location of the narrowing, as well as the physician’s preference.
Bougie dilators are long, flexible, cylindrical tubes with a weighted, tapered end. The physician passes sequentially larger bougies through the narrowed segment, applying both radial and axial pressure along the length of the stricture. This method is useful for longer, convoluted narrowings and can be performed over a guidewire placed beyond the stricture.
Balloon dilation involves specialized, deflated balloons guided through an endoscope to the stricture site. Once positioned across the narrowed area, the balloon is inflated with air or water to a pre-set pressure, exerting a radial force on the tissue. This technique applies pressure more locally and may result in less intense post-procedure pain compared to bougie dilation. Both methods show similar efficacy and safety profiles for benign strictures.
Medical Conditions That Cause Narrowing
Esophageal dilation is necessitated by conditions that lead to a stricture, which is a localized narrowing of the esophageal lumen. The most common cause is peptic stricture, accounting for 70 to 80% of all cases. This is typically a consequence of severe, long-term gastroesophageal reflux disease (GERD), where stomach acid repeatedly damages the lining, leading to inflammation, scarring, and tightening of the tissue.
Other causes include thin membranes known as esophageal rings or webs, such as a Schatzki ring found at the junction of the esophagus and stomach. Eosinophilic esophagitis (EoE) also causes strictures; this is a chronic allergic inflammatory condition where eosinophils, a type of white blood cell, build up in the lining, leading to fibrosis and narrowing.
Achalasia is a distinct motility disorder where the lower esophageal sphincter fails to relax, causing a functional obstruction. Narrowing can also develop as a complication of prior medical treatments, such as radiation therapy for chest cancers or treatments for enlarged veins (varices). Furthermore, ingestion of caustic substances like household cleaners can cause severe chemical burns, resulting in complex strictures.
Navigating the Dilation Procedure
Preparation begins with fasting, requiring the patient to abstain from eating or drinking for at least six hours before the procedure to ensure the stomach is empty. Patients must discuss all current medications with their doctor, particularly blood thinners, which may need to be temporarily adjusted or stopped to minimize bleeding risk.
The procedure is typically performed under conscious sedation to ensure patient comfort and minimize movement. Once sedated, the gastroenterologist inserts a flexible tube called an endoscope through the mouth and into the esophagus. The endoscope contains a camera that allows the physician to directly visualize the narrowed area and guide the dilation instruments.
Using the endoscope as a guide, the appropriate dilator—a balloon or a series of bougies—is advanced to the stricture. The dilator gently stretches the narrowed segment to a predetermined diameter, a process that usually takes only moments. The entire outpatient procedure is short, often lasting about 15 minutes, after which the patient is moved to a recovery area.
Recovery and Long-Term Management
Following dilation, patients are monitored in recovery for one to two hours while the effects of sedation wear off. It is normal to feel groggy and unable to drive, requiring a companion to take them home. Common side effects include a temporary sore throat or discomfort behind the breastbone, which are manageable with over-the-counter pain relief and should resolve within a few days.
The doctor will provide specific post-procedure dietary guidelines, which often involve starting with liquids and soft foods before gradually returning to a normal diet the following day. Patients should maintain hydration and avoid extremely hot or cold beverages initially, as these can irritate the treated area.
Addressing the underlying cause of the stricture is fundamental to long-term management and preventing recurrence. Patients with peptic strictures must continue taking acid-suppressing medications, such as proton pump inhibitors, to reduce the risk of the narrowing returning. Depending on the cause and severity, repeat dilations may be necessary, as some strictures tend to recur. Patients must seek immediate medical attention if they experience severe chest pain, high fever, vomiting blood, or pass black, tarry stools, as these can signal a rare, serious complication like an esophageal perforation.