Esophageal stretching, medically known as esophageal dilation, is a common and minimally invasive procedure designed to widen a narrowed segment of the esophagus, the muscular tube connecting the throat to the stomach. This technique is necessary when a patient experiences difficulty swallowing (dysphagia) due to a physical obstruction. By gently expanding the narrowed area, the procedure restores the passage of food, improving the patient’s ability to eat and quality of life.
Conditions That Cause Esophageal Narrowing
The need for esophageal stretching arises from various conditions that cause scarring or excess tissue growth. The most frequent cause of this narrowing is a peptic stricture, which develops as a complication of long-standing gastroesophageal reflux disease (GERD). The chronic backflow of stomach acid damages the esophageal lining, and the subsequent healing process involves the formation of scar tissue that contracts and tightens the passage.
Another common cause is the presence of Schatzki rings, which are thin, benign rings of tissue that form in the lower esophagus, often at the junction with the stomach. These rings can intermittently cause solid food to feel lodged in the chest. Eosinophilic esophagitis (EoE), a chronic inflammatory condition, also frequently necessitates dilation. In EoE, a buildup of white blood cells called eosinophils causes inflammation and subsequent scarring, making the esophagus stiff and narrow.
Narrowing can also occur as a result of external medical treatments or internal injuries. For example, radiation therapy to the chest or neck for cancer can cause inflammation and scarring of the surrounding tissues, including the esophagus. Similarly, accidental or intentional ingestion of caustic substances, such as household cleaners, causes severe chemical burns that heal with extensive, constricting scar tissue. In all these situations, the resulting stricture creates a mechanical obstruction, making dilation a necessary intervention to alleviate difficulty in swallowing.
How Esophageal Dilation Works
The stretching procedure is performed by a gastroenterologist using an endoscope, a thin, flexible tube equipped with a light and camera. This allows the physician to visualize the narrowed segment, or stricture, and guide the specialized dilation tools directly to the target area. The procedure is minimally invasive and typically done in an outpatient setting.
The two primary methods for dilation are bougie dilation and balloon dilation, with the choice depending on the stricture’s characteristics, such as its location and severity. Bougie dilators are a series of progressively wider, flexible plastic tubes that are passed over a guide wire placed through the stricture and into the stomach. The doctor inserts the bougies one after another, starting small and gradually increasing the size to stretch the esophageal tissue in a controlled manner.
In contrast, balloon dilation utilizes a specialized catheter with a deflated balloon at its tip, which is advanced through the endoscope to the site of the narrowing. Once positioned, the balloon is inflated with water or air to a specific, predetermined pressure and diameter. This method applies radial force to the stricture, stretching the tissue outwards. Balloon dilators are often preferred for shorter strictures, while bougies may be more effective for longer or more complex narrowed segments.
Patient Experience: Preparation, Recovery, and Risks
Before the procedure, patients are required to fast for at least six hours to ensure the stomach is empty, a necessary safety precaution for any procedure involving sedation. Patients typically receive intravenous sedation to help them relax and remain comfortable, and a local anesthetic spray may be used to numb the throat. Patients must discuss all medications with their doctor beforehand, especially blood thinners, as adjustments may be necessary to minimize the risk of bleeding.
Immediately following the dilation, patients are moved to a recovery area for a period of observation until the effects of the sedative wear off. It is common to experience a mild sore throat or slight discomfort in the chest for the rest of the day. The recovery process usually involves a gradual return to eating, starting with liquids and soft foods before advancing to a normal diet, often by the next day, as advised by the physician.
Although the procedure is considered safe and has a high success rate, there are potential, though rare, complications. The most serious risk is perforation, a tear or hole in the wall of the esophagus. Bleeding at the dilation site is another infrequent risk. Patients are instructed to monitor for signs of a problem, such as fever, severe chest pain, or difficulty breathing, and to contact their healthcare provider immediately if these symptoms occur.