How Esophageal Dilation Helps Difficulty Swallowing

Esophageal dilation is a treatment to help stretch, or dilate, abnormal narrowings found in the esophagus. These narrowings are called strictures and can occur from a variety of health problems. They can cause difficulty or discomfort when swallowing.

Esophageal dilation can be done during an endoscopy while you are sedated, or with a numbing spray while you are awake.

This article discusses esophageal dilation, why it is done, and what you can expect when undergoing this procedure.

Why Is Esophageal Dilation Performed?

Over time, different health problems can cause strictures to form in the esophagus, causing a narrowing of the esophagus. These strictures can make it difficult to swallow. You may have a feeling of food getting stuck in your chest. This feeling is because the food has a difficult time moving past the stricture.

In most cases, these strictures are a result of fibrous or collagen tissue accumulation. The disorders that may cause esophageal strictures include:

• Achalasia
• Caustic (chemical) injury
• Eosinophilic esophagitis
• Esophageal cancer
• Gastroesophageal reflux disease (GERD) (most common reason)
• Jackhammer esophagus
• Prior esophageal surgery
• Radiation therapy
• Schatzki’s ring
• Sclerotherapy for esophageal varices

Esophageal dilation is not a cure for any of the disorders above and the symptoms will likely recur in time. However, esophageal dilation can be a useful method of relieving symptoms.

Associated Risks

You should only have esophageal dilation performed by a trained care provider. While esophageal dilation is generally a safe procedure, there are some risks that you should be aware of.

Bleeding and aspiration can occur with almost any procedure involving the airway or esophagus. Your healthcare provider will watch for these complications throughout the procedure. You should seek medical attention if you notice any of the following after the esophageal dilation:

• Difficulty breathing
• Fever
• Chest pain
• Bloody or black bowel movements

The most dangerous complication is the risk of perforation or a hole in the esophagus. This happens in approximately one to four out of 1,000 dilations. If a perforation occurs, surgery may be immediately necessary.

Your risk of perforation may be higher if your stricture is related to radiation therapy. Your risk is also higher if you have a healthcare provider that is inexperienced at performing the surgery.

What to Expect

Prior to the esophageal dilation, you will need to fast. This means you can't have food or water, usually for a minimum of six hours. You should follow your healthcare provider’s pre-procedure instructions regarding fasting time.

Notify your healthcare provider if you are on any medications that thin your blood, such as aspirin or warfarin. You may not need to be taken off the medication. However, your healthcare provider may choose to adjust your dose or take extra precautions. Not telling your healthcare provider about these medications may increase your risk of having a bleeding complication.

You may also be prescribed antibiotics prior to the procedure if you have a history of certain heart diseases. If you take antibiotics with dental work, you should make sure to discuss this with your healthcare provider.

During the procedure, your healthcare provider may use sedation in order to help you relax. If this method is used, you will need someone to drive you home.

Alternatively, your healthcare provider may use a spray anesthetic to numb your throat to perform your procedure. If this method is used, you will be fully awake for the procedure and will be able to drive afterward. Many people, however, prefer sedation because the thought of a long tube inserted into your throat can be scary.

After the procedure, you will be given instructions on when you can eat and drink. Because the anesthetic inhibits normal swallowing functions, fluids should be withheld until the anesthetic has worn off. This is to keep liquid from going into your lungs instead of your stomach.

You will likely also have a mild sore throat for several days after the procedure.

Will I Need Esophageal Dilation Again?

It is common for symptoms to eventually return after an esophageal dilation. How long it takes for symptoms to recur is variable and dependent on many factors including the severity and cause of the stricture.

In many cases, dietary management, use of proton pump inhibitors (PPIs), and other medical therapies can help delay if not prevent the need for future esophageal dilations. Working closely with your healthcare provider and following your individualized treatment plan can help keep symptoms under control for longer periods of time.

Esophageal dilation is a treatment and not a cure. However, symptom relief makes this procedure very helpful for improving your quality of life.

Summary

Esophageal dilation is a procedure that stretches narrow parts of the esophagus called strictures. This procedure can help you swallow food more easily.

Esophageal dilation can be performed under sedation or while you are awake with the help of a throat numbing spray. It is not a cure for the condition that caused the stricture, but it can help provide symptom relief.

Depending on what caused the stricture and how you manage your condition after the procedure, your symptoms may eventually return. When this happens, you may need to undergo the procedure again.