Esophageal dilation is a common medical procedure designed to widen a narrowed segment of the esophagus. When this passage becomes constricted, it leads to difficulty swallowing, a condition known as dysphagia. The goal of the procedure is to gently stretch the narrowed area, allowing food and liquids to pass through more easily. This minimally invasive, outpatient treatment offers significant relief for patients experiencing symptoms from a constricted swallowing tube.
Conditions Requiring Esophageal Dilation
The need for esophageal dilation arises when scar tissue or abnormal growths cause an esophageal stricture. The most frequent cause of stricture formation is chronic gastroesophageal reflux disease (GERD), where repeated exposure to stomach acid damages the lining. This acid injury leads to the formation of a peptic stricture, which gradually constricts the esophagus.
Other conditions, such as Eosinophilic Esophagitis (EoE), also necessitate dilation. EoE is a chronic allergic inflammatory disease where a buildup of eosinophils causes inflammation and subsequent rings or strictures. Narrowing can also be caused by Schatzki’s rings, which are thin, benign folds of tissue typically found at the junction of the esophagus and the stomach.
Less common reasons for narrowing include scarring from swallowing corrosive substances, complications following radiation therapy for chest or neck cancers, and certain motility disorders like achalasia. In all these cases, the restricted passage prevents the smooth transit of a food bolus, resulting in the sensation that food is getting stuck in the throat or chest. Dilation provides a mechanical solution to restore the normal width.
The Esophageal Dilation Procedure
The dilation procedure is generally performed on an outpatient basis and is often combined with an upper endoscopy. Patients typically receive conscious sedation to help them relax and minimize discomfort. The physician first inserts a thin, flexible tube called an endoscope through the mouth to visually assess the narrowed area.
The dilation itself is executed using one of two primary methods: bougie dilation or balloon dilation. Bougie dilation involves passing a series of progressively larger, weighted, flexible plastic tubes, or bougies, through the mouth and down the esophagus. These dilators may be guided over a thin wire that has been placed through the stricture under endoscopic or X-ray guidance. This method is often preferred for strictures that are relatively short, straight, and simple in nature.
Balloon dilation utilizes a specialized catheter with a deflated balloon at its tip, which is guided through the endoscope and positioned precisely within the stricture. The balloon is then inflated with water or air to a specific pressure and diameter, stretching the scarred tissue over a controlled period. Balloon dilation is frequently favored for tighter or more complex strictures, as the pressure can be exerted radially and precisely at the point of maximum narrowing. The procedure is generally brief, often lasting 15 to 30 minutes, and the endoscope is used again afterward to confirm the successful stretching of the tissue.
Post-Procedure Care and Expectations
After the procedure, patients are monitored in a recovery area until the sedative effects wear off, which can take an hour or two. A temporary sore throat or mild chest discomfort is a common and expected side effect. It is mandatory to have a responsible adult drive the patient home due to the lingering effects of the sedation, and patients must refrain from driving or operating machinery for 24 hours.
Dietary instructions immediately following dilation are important for healing. While some numbness in the throat may persist initially, patients are advised to begin with liquids and then progress to soft foods like yogurt, mashed potatoes, or well-cooked eggs. Resuming a normal diet within 24 to 48 hours is encouraged to help maintain the widened diameter of the esophageal passage. Physicians may also prescribe acid-suppressing medication to reduce the risk of a stricture recurring, especially if the original cause was GERD.
Patients must be vigilant for signs of a rare, serious complication, such as esophageal perforation. Immediate medical attention should be sought if a patient experiences severe chest pain, fever, difficulty breathing, or vomiting blood. Depending on the underlying cause, the effects of dilation may not be permanent, and repeat procedures may be necessary over time to manage chronic conditions.