How Esophageal Dilation Helps Difficulty Swallowing

Esophageal dilation is a treatment to help stretch, or dilate, abnormal narrowings found in the esophagus. These narrowings are called strictures and can occur from a variety of health problems. Your doctor will likely send you to either an otolaryngologist (ear, nose and throat doctor) or, more likely, a gastroenterologist (stomach and bowel disorder doctor) in order to have this procedure performed.

There are three different methods to perform esophageal dilation:

  • Weighted bougie – a push type dilator that is either mercury-filled (Maloney) or tungsten-filled (Hurst)
  • Wire-guided dilator – a guide-wire is inserted first and then a polyvinyl dilator (Savary-Gilliard or American) is inserted over the guide-wire
  • Baloon dilator – inserted to the point of the stricture, under endoscopy (using a video endoscope) or fluoroscopy (using x-ray), and then inflating the balloon

Why is Esophageal Dilation Performed?

Over time, different health problems can cause strictures to form in the esophagus causing a narrowing of the esophagus. These strictures can make it difficult to swallow and you may have a feeling of food getting stuck in your chest. This feeling is because the food has a difficult time moving past the stricture. In most cases, these strictures are a result of the accumulation of fibrous or collagen tissue accumulation.

Here is a list of disorders that may benefit from using esophageal dilation:

Esophageal dilation is not a cure for any of the disorders above and the symptoms will likely recur in time. However esophageal dilation can be a useful method in relieving symptoms.

Risks Associated With Esophageal Dilation

You should only have esophageal dilation performed by a trained care provider. While esophageal dilation is generally a safe procedure, there are some risks that you should be aware of.

Even though the risks sound scary, esophageal dilation, in general, is safe to perform in an outpatient setting and does not need to be performed in a hospital.

Bleeding and aspiration can occur with almost any procedure involving the airway or esophagus. Your doctor will observe for these complications throughout the procedure. You should seek medical attention if you notice any of the following after the esophageal dilation:

  • Difficulty breathing
  • Fever
  • Chest pain
  • Bloody or black bowel movements

The most dangerous complication is the risk for perforation or a hole in the esophagus. This can occur approximately every 1-4 times out of 1,000 dilations. If a perforation occurs, surgery may be required immediately. Your risk is higher for this complication if your stricture is related to radiation therapy. Your risk is also higher if you have a physician that hasn’t performed the surgery frequently.

What to Expect With an Esophageal Dilation

Prior to the esophageal dilation, you will need to fast (not have food or water) for a minimum of 6 hours. You should follow your doctor’s pre-procedure instructions regarding fasting time.

If you are on any medications that thin your blood (aspirin, warfarin, etc…) you should notify your physician. You may not need to be taken off the medication. However, your doctor may choose to adjust your dose or take extra precautions. Not telling your doctor about these medications may increase your risk of having a bleeding complication.

You may also be prescribed antibiotics prior to the procedure if you have a history of certain heart diseases. If you take antibiotics with dental work, you should make sure to discuss antibiotics with your doctor.

During the procedure, your doctor may use sedation in order to help you relax and not remember the procedure. If this method is used, you will need someone to drive you home, as common medications used in this procedure include: fentanyl, versed, or propofol. All these medications require that you do not drive for 24 hours.

Alternatively, your doctor may use a spray anesthetic to numb your throat to perform your procedure. If this method is used, you will be fully awake for the procedure and would be able to drive. Many people, however, prefer to use sedation, because the thought of a long tube being inserted into your throat down to your stomach can be scary, particularly if you are prone to claustrophobia.

After the procedure, you will be given instructions on when you can eat and drink. Drinking will be withheld until any anesthetic effects have worn off. This is so that you do not have liquid go into your lungs instead of your stomach, since the anesthetic inhibits the normal swallowing functions. You will likely also have a mild sore throat for several days after the procedure.

Will I Need More Than One Esophageal Dilation?

It is common for symptoms to eventually return after an esophageal dilation. How long it takes for symptoms to recur is variable and dependent on many factors including the severity and cause of the stricture.

In many cases, dietary management, use of proton pump inhibitors (PPIs), and other medical therapies can help delay if not prevent the need for future esophageal dilations. Working closely with your doctor and following your individualized treatment plan can help keep symptoms under control for longer periods of time.

Esophageal dilation is a treatment and not a cure, however, the symptom relief will make this procedure very useful to improve your quality of life.

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Article Sources

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