Difficulty swallowing, known as dysphagia, can make eating and drinking uncomfortable or painful. This often occurs when the esophagus, the muscular tube connecting the throat to the stomach, narrows. Esophageal stretching, also called esophageal dilation, is an effective medical procedure designed to alleviate these symptoms. It opens constricted areas within the esophagus, allowing food and liquids to pass more easily.
Reasons for Esophageal Stretching
Esophageal stretching widens abnormally constricted segments of the esophagus, which can make food passage difficult. This narrowing stems from various medical conditions.
One frequent cause is peptic strictures, which result from chronic acid reflux (GERD). Persistent inflammation and scarring in the lower esophagus occur when stomach acid damages the lining. As it heals, scar tissue forms, gradually constricting the passageway and making food movement challenging.
Eosinophilic esophagitis (EoE) is another reason for esophageal narrowing. This allergic inflammatory condition involves an accumulation of eosinophils, a type of white blood cell, in the esophageal lining. Chronic inflammation from EoE can cause the esophagus to develop rings, furrows, or strictures, leading to persistent difficulty swallowing and sometimes food impaction.
Schatzki’s rings are benign, thin tissue rings that form where the esophagus meets the stomach. They commonly cause intermittent dysphagia, often triggered by eating solid foods quickly. These rings are associated with chronic acid reflux.
Esophageal webs are delicate, thin membranes that develop in the upper esophagus. They can partially obstruct the esophageal lumen, causing difficulty swallowing, especially with solid foods. They are sometimes associated with conditions like Plummer-Vinson syndrome.
Less common reasons for esophageal narrowing include scarring from accidental ingestion of caustic substances. Radiation therapy for chest cancer can also cause inflammation and fibrosis, narrowing the esophagus over time. Additionally, strictures may develop as a complication following esophageal surgery.
Understanding the Esophageal Stretching Procedure
Esophageal stretching is often performed as an outpatient procedure. Beforehand, patients fast for several hours to ensure the esophagus is empty. Sedation options, ranging from conscious sedation (relaxed but awake) to general anesthesia (fully asleep), will be discussed.
During the procedure, a gastroenterologist uses an endoscope, a thin, flexible tube with a camera and light, to visualize the narrowed esophageal area. The endoscope is guided through the mouth and into the esophagus. Two methods are used for dilation: balloon dilators or bougies.
Balloon dilators involve passing a deflated balloon through the endoscope to the stricture. It is then inflated with water or air to a specific size, gently stretching the constricted tissue. This inflation is maintained for a short period to gradually widen the passageway. Alternatively, bougies are flexible plastic dilators of increasing diameters. They are passed over a guide wire inserted through the stricture, with the physician gradually introducing larger bougies to progressively stretch the narrowed segment.
After the procedure, patients spend a short time in a recovery area while the effects of sedation wear off. It is common to experience a mild sore throat or slight chest discomfort for a day or two. Patients are advised to consume soft foods and liquids initially, gradually returning to their regular diet. While relief from swallowing difficulties is often immediate, some individuals may require repeat dilations over time, depending on the underlying cause of the esophageal narrowing.