The esophagus is a hollow, muscular tube that transports food and liquids from the throat down to the stomach. Its primary function is to propel swallowed material through coordinated muscle contractions, a process known as peristalsis. The esophagus can be stretched, but only as a therapeutic intervention when a medical condition has caused it to narrow. This narrowing, medically termed a stricture, interferes with the passage of food and causes difficulty swallowing. The procedure used to correct this is called esophageal dilation, which gently stretches the constricted section to restore the tube’s proper diameter.
Causes of Esophageal Narrowing
Esophageal stretching is necessary when damage to the tube’s lining leads to the formation of stiff, non-elastic scar tissue that restricts the opening. The most frequent cause of this scarring is long-term, untreated Gastroesophageal Reflux Disease (GERD). When stomach acid repeatedly backs up, it causes chronic inflammation and ulceration, which heal with fibrous tissue that contracts and narrows the passageway.
Another cause is Eosinophilic Esophagitis (EoE), an allergic inflammatory condition where eosinophils (a type of white blood cell) build up in the lining. This inflammation can lead to the formation of rings or diffuse narrowing that impairs swallowing. Other causes include the ingestion of caustic substances, which cause deep burns and extensive scarring. Strictures can also be congenital or develop after radiation therapy to the chest or neck for cancer treatment.
How Esophageal Dilation is Perform
Esophageal dilation is a specialized, minimally invasive procedure typically performed by a gastroenterologist using an endoscope. The patient receives a sedative and a local anesthetic before the flexible, lighted endoscope is inserted. The doctor visualizes the stricture to determine the most appropriate stretching technique.
Balloon Dilation
This method involves threading a deflated balloon catheter through the endoscope and positioning it precisely within the stricture. The balloon is then inflated with water or air to a specific, pre-set pressure for 30 to 60 seconds to gently expand the constricted tissue. This method allows for a focused stretch on a single, short stricture.
Bougie Dilation
Bougie dilation involves passing a series of tapered, flexible plastic tubes, called bougies, over a guide wire placed through the stricture and into the stomach. The doctor introduces the bougies sequentially, starting with a smaller diameter and gradually increasing the size. This process slowly and methodically stretches the esophagus to the desired width and is often preferred for managing multiple or longer strictures. Both techniques aim for a gradual, controlled stretch to avoid tearing the tissue, which may require multiple treatment sessions over time to achieve the full diameter.
Recovery and Risk Management
Following the dilation, patients are monitored until the sedative effects wear off. It is common to experience a mild sore throat or temporary chest discomfort, which usually resolves within 24 hours. Patients are advised to consume only clear liquids initially and transition to a soft diet for the first day to protect the stretched tissue.
Risks and Complications
Esophageal dilation is generally considered low-risk, but the most significant complication is perforation (a tear in the lining). This complication is rare, occurring in less than one in 4,000 procedures, but it can be life-threatening and may require emergency surgery. Other potential risks include bleeding at the dilation site or an adverse reaction to the sedation. Patients must immediately report symptoms like fever, severe chest pain, or difficulty breathing, as these may indicate a complication.
Preventing Recurrence
The long-term success of the procedure depends on treating the underlying cause of the stricture. Since narrowing is often caused by chronic inflammation, the stricture can recur if the inflammation is not controlled. To prevent the need for repeat dilations, doctors frequently prescribe acid-suppressing medications, such as proton pump inhibitors (PPIs), to manage acid reflux. Repeat dilation sessions are common for complex or recurrent strictures to maintain the esophageal passageway’s openness.