Esophageal dilation is a common, minimally invasive procedure used to widen an abnormally narrow section of the esophagus. This narrowing, medically termed a stricture, causes difficulty swallowing food and liquids, a symptom known as dysphagia. The procedure involves stretching the constricted area to restore a normal passageway for food to reach the stomach. As an outpatient treatment, esophageal dilation offers a high success rate in immediately improving a patient’s ability to eat comfortably.
Medical Reasons for Esophageal Narrowing
The primary reason for needing the esophagus stretched is the presence of an esophageal stricture, typically caused by chronic damage leading to scar tissue formation. The most frequent cause of this scarring is long-standing gastroesophageal reflux disease (GERD), which accounts for 70% to 80% of benign strictures. Stomach acid repeatedly flowing back up into the esophagus irritates the sensitive lining, causing inflammation called esophagitis. Over time, the body attempts to heal this repeated injury by laying down scar tissue, which is less flexible and narrows the tube’s diameter.
Another condition that frequently leads to narrowing is Eosinophilic Esophagitis (EoE), an allergic inflammatory disorder. In EoE, a large number of white blood cells called eosinophils accumulate in the esophageal lining, triggering chronic inflammation. This inflammation results in the formation of rings or webs of tissue, which are responsive to dilation.
Strictures can also arise from damage caused by medical treatments or accidental ingestion of corrosive substances. Radiation therapy administered to the chest or neck area for cancer can inflame the esophagus, leading to scarring and subsequent narrowing. Strictures resulting from the accidental swallowing of caustic materials, such as lye or battery acid, cause severe chemical burns and extensive scar formation. These resulting strictures from radiation or caustic injury are generally more complex and difficult to treat than those caused by acid reflux.
How Esophageal Dilation is Performed
The procedure for esophageal dilation is performed with the patient under sedation to ensure comfort and minimize movement. A gastroenterologist first inserts a thin, flexible tube equipped with a camera and light, called an endoscope, through the mouth and into the esophagus. The endoscope allows the doctor to visualize the narrowed segment, assess its severity, and ensure the correct area is treated.
There are two main approaches used to stretch the stricture: bougies and balloon dilators. Bougies are long, flexible, cone-shaped tubes of increasing diameter that are passed sequentially down the esophagus over a guiding wire. The doctor starts with a small bougie and gradually uses larger sizes to stretch the scar tissue incrementally.
Alternatively, a balloon dilator may be used, which is inserted through the channel of the endoscope to the site of the narrowing. Once correctly positioned, the balloon is inflated with water or air to apply radial force against the stricture. This method is effective for most types of strictures. Fluoroscopy, a type of moving X-ray, may be used to guide the placement of the tools and confirm the stricture is widening. The dilation procedure typically takes about 15 to 30 minutes, aiming to widen the esophagus enough to alleviate symptoms without causing injury.
Immediate Recovery and Long-Term Results
Following the dilation, patients are monitored in a recovery area for an hour or two while the sedative medication wears off, and most are able to return home the same day. It is common to experience a mild sore throat or slight discomfort behind the breastbone for a day or two afterward. These minor side effects are manageable with over-the-counter pain relievers or throat lozenges.
Immediate dietary instructions involve starting with clear liquids and slowly progressing to soft foods before resuming a regular diet, often within 24 hours. Patients are advised to contact their doctor immediately if they experience severe chest pain, difficulty breathing, fever, or signs of bleeding, such as dark or bloody stools. These symptoms can indicate a rare but serious complication like a tear in the esophageal lining.
The results of esophageal dilation are positive, providing immediate relief from swallowing difficulties. However, the long-term outlook depends on the underlying cause of the stricture. For chronic conditions like GERD, the narrowing often recurs because the underlying disease process continues, meaning many patients require repeat dilations.
In these cases, doctors often prescribe acid-suppressing medications to help prevent the stricture from returning quickly. A scheduled program of repeat dilations can improve the long-term outcome, with studies showing that the need for further procedures often decreases after about 18 months of treatment.