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What is Dilatation of Esophageal strictures?

Dilatation of Oesophageal strictures is an endoscopic procedure performed for the treatment of a condition called an oesophagal stricture. Oesophagal stricture is the scarring or narrowing of the oesophagus from reflux of stomach acid in individuals with heartburn.

The oesophagus, also referred to as the swallowing tube, allows food and liquids to pass through it to your stomach. Individuals with a narrowed section of the oesophagus commonly have difficulty in swallowing with a feeling of food “stuck” in the throat or chest area, causing pain or discomfort. Oesophageal dilation is a procedure using an endoscope to help dilate or widen the narrowed or constricted section of the oesophagus, allowing unhindered passage of food and liquids. An endoscope is a long, thin, flexible tube with a camera and light source at the end. Images from the camera are transmitted to a large monitor for your physician to view the inside of your oesophagus.

Indications for Dilatation of Esophageal Strictures

Dilatation for oesophagal strictures is mainly recommended for the treatment of oesophagal strictures as a result of conditions, such as:

  • Peptic ulcer disease
  • Gastroesophageal reflux disease (GERD)
  • Oesophagal cancer
  • Scarring after radiation treatment to the neck or chest
  • Oesophagal varices (enlarged veins in the oesophagus)
  • Hiatal hernia
  • Schatzki's ring: A narrowing of the lower oesophagus that can cause swallowing difficulty (dysphagia).
  • A history of dysphagia
  • Alcohol abuse
  • Prolonged use of nasogastric tube

Preparation for Dilatation of Esophageal Strictures

Pre-procedure preparation for dilatation of oesophagal strictures may involve the following steps:

  • Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
  • You will be asked if you have allergies to medications, anaesthesia, or latex.
  • You should inform your doctor of any medications or supplements that you are taking or any medical conditions you have such as lung or heart disease.
  • You may need to refrain from certain medications such as blood thinners or anti-inflammatories for a week or two prior to the procedure.
  • You should not consume any solids or liquids at least 6 hours prior to the procedure.
  • Arrange for someone to drive you home after the procedure, as you may feel groggy due to the effects of anaesthesia/sedation medicines.
  • A written consent will be obtained from you after the procedure has been explained in detail.

Procedure for Dilatation of Esophageal Strictures

  • The procedure is performed under general or local anaesthesia to numb your throat. You may also be given sedation medicines to keep you relaxed.
  • Your physician inserts an endoscope through your mouth into your oesophagus. Fluoroscopy may be used to create a continuous X-ray image on a monitor throughout the procedure.
  • The stricture areas are widened by the use of certain special instruments, which are carefully inserted into your oesophagus through your mouth. Different types of instruments can be used for this process and they include:
  • Balloon dilator: A tiny, deflated balloon is inserted into the area of stricture through an endoscope. The balloon is slowly inflated and later deflated when the stricture is widened enough. 
  • Guided wire dilator: A thin wire is carefully eased down the oesophagus. A small tube that is wider on one end is guided down the wire into the stricture to stretch it. 
  • Bougies: These are cone-shaped, weighted tubes of different sizes. These cones will be inserted one after the other, in the ascending order of size, till the stricture is inflated to the required size.
  • Once the procedure is complete, the scope and instruments are withdrawn and you are shifted to the recovery room.
  • The oesophagal stricture dilatation procedure takes about 30 minutes to complete.

Post-Procedure Care and Recovery

Post-procedure care and instructions may involve the following:

  • You will be transferred to the recovery area where you will be asleep until the sedation or anaesthesia wears off. Your nurse will monitor your vital signs as you recover.
  • It is normal for you to feel soreness in the throat due to the tube used as well as pain or discomfort once you gain consciousness.
  • You will be given pain medicines and anti-nausea medications to relieve your pain and discomfort.
  • You should be able to take liquids once your anaesthetic effect wears off and you no longer feel numbness in your throat.
  • You should be able to resume your normal diet the same day or the next day, unless your physician instructs otherwise.
  • A follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Dilatation of oesophagal strictures is a relatively safe procedure; however, as with any procedure, some risk and complications may occur, such as:

  • Infection
  • A hole or tear in the lining of the oesophagus
  • Anaesthetic complications
  • Bleeding
  • Need for repeat/additional procedures

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