Esophageal dilation is a procedure to widen a narrowed section of the esophagus, the muscular tube connecting the throat to the stomach. This intervention improves the passage of food and liquids, addressing swallowing difficulties and allowing for comfortable eating and drinking.
Conditions Requiring Dilation
A narrowing of the esophagus, known as an esophageal stricture, often requires dilation. The most common cause is chronic acid reflux, or gastroesophageal reflux disease (GERD). Stomach acid repeatedly flows back into the esophagus, irritating the lining and causing inflammation and scar tissue formation. This scarring can progressively narrow the esophageal passage.
Other conditions include eosinophilic esophagitis, an inflammatory disorder causing swelling and strictures. Radiation therapy to the chest or neck, often for cancer treatment, can also induce inflammation and scarring that narrows the esophagus. Less common causes involve esophageal rings or webs, which are thin layers of excess tissue, or achalasia, a condition affecting the lower esophageal sphincter’s ability to relax. Swallowing caustic substances or injury from prolonged nasogastric tube use can also lead to stricture formation.
How Dilation is Performed
Esophageal dilation is commonly performed during an endoscopy. An endoscope, a thin, flexible tube with a camera and light, is guided through the mouth into the esophagus, allowing the physician to visualize the narrowed area. Before the procedure, a local anesthetic spray may numb the throat, and sedation is given intravenously for patient comfort.
Two methods are used: balloon dilation and bougie dilation. In balloon dilation, a deflated balloon on a catheter is passed through the endoscope to the stricture. The balloon is then inflated with water or air, stretching the esophageal walls. For bougie dilation, progressively larger, cone-shaped plastic tubes, called bougies, are passed over a guide wire or directly through the esophagus to gradually widen the stricture. The choice of method depends on the stricture’s characteristics and the physician’s assessment.
Preparing for and Recovering from Dilation
Preparation for esophageal dilation involves ensuring the stomach is empty for safety and clear visualization. Patients are advised to refrain from eating or drinking for at least six hours prior. Patients should discuss all current medications, including all prescription and over-the-counter medications, with their healthcare provider. Adjustments may be necessary for certain medications, such as blood thinners or diabetes medications, to reduce complication risks.
Following the procedure, patients remain in a recovery area while sedation effects wear off. A mild sore throat or chest discomfort may occur, manageable with over-the-counter pain relievers. Most individuals can resume usual activities the next day, but someone must drive them home due to sedation. Dietary recommendations include starting with fluids and gradually reintroducing soft foods.
Understanding Potential Outcomes and Follow-Up
Esophageal dilation is effective in alleviating swallowing difficulties caused by strictures. Patients often experience significant symptom improvement, allowing them to eat and drink more comfortably. While safe, potential complications, though uncommon, can occur, including a small tear or hole in the esophageal lining (perforation) or bleeding. The risk of perforation is low, estimated at one to four per 1,000 dilations.
Follow-up care is important for managing esophageal strictures, as the underlying condition requires ongoing attention. Depending on the cause and severity, repeat dilations may be necessary to maintain the esophageal opening. For strictures caused by acid reflux, long-term medication to reduce stomach acid is often prescribed to prevent recurrence. Regular monitoring and adherence to treatments contribute to sustained relief and improved quality of life.