September 9, 2015
What is an Esophageal Dilation?
Esophageal dilation is a procedure done enlarge a narrow or strictured part of the esophagus, or in some cases to dilate the narrowed exit of the stomach or stricture in the duodenum (first part of the intestine). After gastric bariatric surgery, for example, sometimes the exit of the pouch has scarred and food will not pass, so dilation is necessary. Dilation is performed using special catheters with expandable balloons, or by passing a specially designed tapered plastic tube over a guidewire.
How do I prepare for my procedure?
The procedure is part of an upper GI endoscopy, so for information about the basic part of the procedure see our separate brochure on Upper GI Endoscopy. There are ordinarily no special preparations just for the dilation portion of the procedure, though sometimes we have you stop certain blood thinners ahead of time.
How is the procedure performed?
Ordinarily you are quite strongly sedated during the endoscopy procedure, whether or not a dilation is done. When dilation is necessary, either the physician passes a balloon catheter down the length of the scope, positions the catheter across the narrow zone and expands the balloon(s) to the desired diameter. Other times, the physician passes a thin flexible metal guidewire through the scopoe, leaves it with the tip in lower end of the stomach, removes the scope and passes the dilator device over the guidewire and down across the stricture. Sometimes the scope is then passed again to examine the area dilated. Sometimes you might sense some transient pressure in chest or upper abdomen during dilation, or after it is done, but ordinarily no significant pain; most people don’t know a dilation was done until the doctor tells you it was. Rarely, Xray fluoroscopy is needed to guide positioning of the dilator.
What can I expect after my procedure?
After the dilation is done, you will probably be observed for a short period of time and then allowed to return to your normal activities. You may resume drinking when the sedation, and/or topical anesthetic, have worn off. Any special diet instructions, if needed, will be provided. Most patients experience no unusual symptoms after this procedure, but you might experience a mild sore throat for the remainder of the day. If you received sedatives, you wouldl be monitored in a recovery area until you are ready to leave. You will not be allowed to drive after the procedure even though you might not feel tired. Someone needs to drive you home, or drive for you anytime the day of the procedure, because the sedative can affect your judgment and reaction times for the rest of the day.
How long and where does the esophageal dilation take place?
The procedure is usually done in a outpatient endoscopy center, sometimes at the hospital outpatient GI lab. The dilation adds a little time to the endoscopy procedure, perhaps up to about 15 minutes, but timing will depend on the details of what needs to be dilated.
Are repeat dilations necessary?
Depending on the degree and cause of the narrowing or stricture, it is common to require repeat dilations. This allows the dilation to be performed gradually and decreases the risk of complications. Once the stricture, or narrowed esophagus, is completely dilated, repeat dilations may not be required. If the stricture was due to acid reflux, acid blocker medicines can decrease the risk of stricture recurrence. Your doctor will advise you on this.
Are there any complications involved with esophageal dilation?
Although complications can occur even when the procedure is performed correctly, they are rare when performed by doctors who are specially trained. A perforation, or hole, of the esophagus lining occurs in a small percentage of cases and may require surgery. A tear of the esophagus lining may occur and bleeding may result. There are also possible risks of side effects from sedatives. It is important to recognize early signs of possible complications. If you have chest pain, fever, trouble breathing, difficulty swallowing, bleeding or black bowel movements after the test, tell your doctor immediately.
Are dilation procedures done in other GI regions?
Dilations of colon strictures, or strictures with J pouches in patients with these procedures, are sometimes performed. The basic process is similar; the main difference is the scope used is a colonoscope or a scope passed into the intestine J pouch. Bile duct or pancreas duct strictures are treated during ERCP and this procedure is described in a separate brochure.