What Is Esophageal Stricture?
An abnormal tightening of the esophagus is termed esophageal strictures. These esophageal strictures can restrict food and liquid intake from the mouth to the stomach. It makes swallowing difficult, and individuals experience food stuck in their throats. Gastroesophageal reflux is the most common cause of the strictures, but other conditions like cancer can also propagate sphincters of the esophagus. Esophageal dilation helps to widen these esophageal strictures and the esophagus and thus reduces the symptoms.
What Is Esophageal Dilation?
Esophageal dilation is a technical procedure that, with the help of endoscopic dilation of the esophagus is done which improves dilating of the narrow esophagus. These are clear symptoms like difficulty swallowing. It is a prompt treatment in cases of a narrow esophagus but is also accompanied by serious complications like esophageal perforation. This procedure can produce significant anxiety in individuals.
Indications of Esophageal Dilation
Esophageal stricture is used to treat a number of medical conditions that narrow the esophageal lumen or decrease the motility of the distal esophagus. The conditions include:
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Achalasia (a rare disorder that makes it difficult to swallow food and liquid through the esophagus).
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Peptic stricture.
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Rarely esophageal cancer.
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Scleroderma esophagus.
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Schatzki rings (a circular membrane of mucosa and submucosa formed at the squamocolumnar junction of the distal esophagus).
Types of Dilators for Esophageal Dilation
There are three major types of esophageal dilators they are:
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Bougie Over Guidewire Dilators: An endoscope is usually used to evaluate the anatomy, and a guide wire is passed past the obstruction. Also, fluoroscopy can be done. Bougies are sequentially introduced by a guide wire and increased in size.
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Mercury-Weighted Bougies: Bougies are blindly inserted into the esophagus. They are passed sequentially, increasing the size of the obstructed narrow lumen. Appropriate precaution is used in cases of narrow strictures to avoid proximal obstruction.
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Pneumatic Dilation or Balloon Dilation: This is done at the time of fluoroscopy or endoscopy. A balloon is inserted as deflated from inside the narrow lumen. Then the balloon is inflated with air, and certain pressure is present to give the appropriate circumference.
What Is Involved in Esophageal Dilation?
Esophageal dilation is done in several ways, depending on need and other procedures that have to be done at the same time. A series of flexible tubes are used to insert into the esophagus stretching it, and in other conditions, even a special balloon is inserted that is inflated and removed. Even an upper I endoscope is used to dilate the esophagus. This allows checking for any abnormalities in the stomach, esophagus, and duodenum. This does not interfere with the ability to breathe. Esophageal dilation is performed usually under sedation so after the procedure usually individuals need someone to accompany them on their way back home.
What Are the Instructions Given Before an Esophageal Dilation?
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Keep the healthcare provider informed about the medications taken, supplements, or any blood thinners.
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Inform the doctor about any other medical condition suffered by the patient, like lung or heart disease. Also, inform about any allergies to any medication.
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Follow the eating and drinking instructions provided by the health care provider that will help to have an empty stomach for the procedure.
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Arrange for a friend or family member to accompany the patients to their homes after the procedure.
How Is Esophageal Dilation Done?
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The procedure takes about 15 to 20 minutes. Local anesthesia is given to numb the throat, and sometimes anesthesia is given to relax the individual.
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An endoscope is used. An endoscope is a narrow thin, flexible tube with a lightheaded camera that helps to view inside the esophagus. This endoscope is inserted in the mouth rather than the esophagus. Fluoroscopy can also be used. An imaging technique using an endoscope and X-ray creates an image on the monitor throughout the process.
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With the help of special guidance, special instruments are carefully guided through the mouth down to the esophagus, which widens and dilates the strictures and removes them. The instruments used depend on the cause and width of the structure.
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Other than bougies and guided wire dilators, balloon dilators are most commonly used. In this procedure, a deflated balloon is inserted with the help of an endoscope. The balloon is then inflated. Later, slowly and sequentially, the deflation of the strictures occurs, and the strictures are widened enough. This procedure is also successful in stretching the lower esophageal sphincter in cases of achalasia.
What Happens After the Esophageal Dilation Procedure?
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The healthcare provider must keep the patient under observation.
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A sore throat may develop for the rest of the day.
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Pain behind the breast bone can be experienced.
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Drinking can be started after the numbness of the throat goes away, and eating can be resumed the next day.
Benefits of Esophageal Dilation
The benefits of esophageal dilation are:
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Can resume drinking, eating, and other activities quickly.
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Effective in relieving esophageal stricture.
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Side effects are usually minimal.
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Only one procedure is usually needed.
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Easy and quick recovery.
What Changes Occur to the Esophagus After an Esophageal Dilation?
The esophagus can be stretched enough even in one procedure. The esophagus needs to be stretched a bit more a little bit, the health care providers may gradually perform multiple procedures. If the esophagus is narrowed by conditions like gastroesophageal reflux syndrome (GERD), acid-reducing medication will help to prevent reoccurrence.
Complications Of Esophageal Dilation
The complications associated with esophageal dilation are:
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Mediastinitis.
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Infection.
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Risk of anesthesia.
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Hematemesis (blood vomit).
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Odynophagia (painful swallowing).
What Are the Emergency Conditions to Contact the Health Care Provider Immediately After the Procedure?
Contact the healthcare provider if any of the following are experienced:
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Trouble swallowing.
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Chest pain.
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Bleeding.
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Black tarry, bloody stools.
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Fever of 100.4 degrees Fahrenheit or higher.
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Blood vomits that smell like coffee grounds.
Conclusion:
Esophageal dilation of the esophagus strictures is both a rewarding and challenging procedure for the health care provider. Experience and patience are required for a successful procedure in terms of efficacy and minimal complications. Sometimes the procedure needs to be repeated more than twice, and it depends on the extent and cause of the narrowing of the lumen. Repeated procedures slowly dilate the lumen and reduce the risk and complications of the procedure.
