Esophageal dilation is a procedure that allows your doctor to dilate,
or stretch, a narrowed area of your esophagus [swallowing tube].
Doctors can use various techniques for this procedure. Your doctor
might perform the procedure as part of a sedated endoscopy.
Alternatively, your doctor might apply a local anesthetic spray to the
back of your throat and then pass a weighted dilator through your mouth
and into your esophagus.
Why is it Done?
The most common cause of narrowing of the esophagus, or stricture, is
scarring of the esophagus from reflux of acid occurring in patients
with heartburn. Patients with a narrowed portion of the esophagus often
have trouble swallowing; food feels like it is "stuck" in the chest
region, causing discomfort or pain. Less common causes of esophageal
narrowing are webs or rings (which are thin layers of excess tissue),
cancer of the esophagus, scarring after radiation treatment or a
disorder of the way the esophagus moves [motility disorder].
How Should I Prepare for the Procedure?
An empty stomach allows for the best and safest examination, so you
should have nothing to drink, including water, for at least six hours
before the examination. Your doctor will tell you when to start fasting.
Tell your doctor in advance about any medications you take,
particularly aspirin products or anticoagulants (blood thinners). Most
medications can be continued as usual, but you might need to adjust
your usual dose before the examination. Your doctor will give you
specific guidance. Tell your doctor if you have any allergies to
medications as well as medical conditions such as heart or lung
disease. Also, tell your doctor if you require antibiotics prior to
dental procedures, because you might need antibiotics prior to
esophageal dilation as well.
What Can I Expect during Esophageal Dilation?
Your doctor might perform esophageal dilation with sedation along with
an upper endoscopy. Your doctor may spray your throat with a local
anesthetic spray, and then give you sedatives to help you relax. Your
doctor then will pass the endoscope through your mouth and into the
esophagus, stomach and duodenum. The endoscope does not interfere with
your breathing. At this point your doctor will determine whether to use
a dilating balloon or plastic dilators over a guiding wire to stretch
your esophagus. You might experience mild pressure in the back of your
throat or in your chest during the procedure. Alternatively, your
doctor might start by spraying your throat with a local anesthetic.
Your doctor will then pass a tapered dilating instrument through your
mouth and guide it into the esophagus.
What Can I Expect after Esophageal Dilation?
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 anesthetic no longer causes numbness
to your throat, unless your doctor instructs you otherwise. Most
patients experience no symptoms after this procedure and can resume
eating the next day, but you might experience a mild sore throat for
the remainder of the day.
If you received sedatives, you probably will 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. You
should arrange for someone to accompany you home, because the sedatives
might affect your judgment and reflexes for the rest of the day.
What are the Potential Complications of 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. Complications from
heart or lung diseases are potential risks if sedatives were used.
It is important to recognize early signs of possible complications.
If you have chest pain, fever, difficulty swallowing, bleeding or black
bowel movements after the test, tell your doctor immediately.
Will Repeat Dilations be Necessary?
Depending on the degree of narrowing of your esophagus and its cause,
it is common to require repeat dilations. This allows the dilation to
be performed gradually and decreases the risks of the procedure. Once
the stricture, or narrowed esophagus, is completely dilated, repeat
dilations may not be required. If the stricture was due to acid reflux,
acid-suppressing medicines can decrease the risk of stricture
Reprinted from the American Society for Gastrointestinal Endoscopy (ASGE).