Esophageal dilation is a medical procedure designed to widen a narrowed section of the esophagus, the muscular tube connecting the throat to the stomach. This intervention helps alleviate symptoms like difficulty swallowing, which can significantly impact a person’s ability to eat and drink comfortably. By gently stretching the constricted area, the procedure aims to improve the passage of food and liquids through the digestive tract.
Medical Reasons for Esophageal Dilation
A narrowed esophagus, medically termed a stricture, can arise from various conditions that cause inflammation or scarring within the esophageal lining. One common cause is gastroesophageal reflux disease (GERD), where stomach acid repeatedly flows back into the esophagus, leading to damage and the formation of scar tissue. This scar tissue then causes the esophagus to narrow, making swallowing difficult.
Other medical conditions can also lead to esophageal narrowing. Eosinophilic esophagitis, an allergic inflammatory condition, can cause the esophageal tissue to become inflamed and stiffen. Radiation therapy, sometimes used to treat cancers in the chest area, can also result in scarring and stricture formation in the esophagus as a side effect. Conditions such as achalasia, where the lower esophageal sphincter does not relax properly, or esophageal rings, which are bands of scar tissue, can also necessitate dilation to improve function.
How Esophageal Dilation is Performed
Esophageal dilation is typically performed as an outpatient procedure by a gastroenterologist. The process often involves sedation to ensure patient comfort, though some procedures may use a local anesthetic spray in the throat. A thin, flexible tube with a camera and light, called an endoscope, is gently inserted through the mouth and guided into the esophagus. This allows the doctor to visualize the narrowed area directly.
Once the stricture is identified, specialized tools are advanced through the endoscope to perform the dilation. One common method involves using a deflated balloon, which is positioned within the narrowed segment and then inflated to a specific pressure to gently stretch the esophageal walls. Another technique utilizes bougies, which are progressively larger, tapered plastic or rubber dilators that are passed over a guidewire to gradually widen the constricted area. The procedure is controlled and precise, aiming to achieve adequate widening without causing harm to the esophageal tissue.
Potential Risks and Complications
While esophageal dilation is generally considered a low-risk procedure with a high success rate, potential complications can occur. The most serious, though rare, risk is esophageal perforation, which is a tear in the wall of the esophagus. This can lead to severe pain, fever, and potentially life-threatening infections if not promptly addressed. The likelihood of perforation is generally low, estimated to occur in less than 1% of cases.
Another possible complication is bleeding at the dilation site, which can manifest as coughing up blood or blood in vomit. While typically minor, significant bleeding may require further medical intervention. Aspiration is another risk, where food or liquid accidentally enters the lungs instead of the stomach, potentially leading to pneumonia. This can happen if stomach contents are regurgitated during or immediately after the procedure.
Patients should be aware of warning signs that might indicate a complication. These can include severe or worsening chest pain, especially if it radiates to the back or neck, persistent difficulty breathing, persistent fever (above 100.4°F / 38°C), persistent difficulty swallowing that does not improve, vomiting blood, or black, tarry stools. Such symptoms warrant immediate medical attention.
Post-Procedure Care and Warning Signs
Following esophageal dilation, it is common to experience some mild discomfort, such as a sore throat or slight chest discomfort. These sensations are usually temporary and can often be managed with over-the-counter pain relievers. Healthcare providers typically provide specific instructions for post-procedure care, which may include temporary dietary modifications, such as starting with liquids and gradually advancing to soft foods.