Esophageal dilatation is a procedure for opening a blocked or constricted section of the esophagus. (The esophagus is a long tube, known colloquially as the "gullet," through which food passes on its way to the stomach.) The procedure is normally performed by passing bougies, or dilators, through the constricted section of the esophagus, in order to break the constricting tissues or stretch the narrowed section. The procedure is common, and complications are rare.
Blockage or stricture of the esophagus is a fairly common condition, and it has many possible causes. It can be hereditary: some people are born with partial or complete blockages. In children, it is often caused by the ingestion of caustic agents, which can burn the esophagus and leave it narrowed by tissue. The most common cause is acid peptic stricture, in which the recurrent reflux of stomach acids into the esophagus leads to inflammation and scarring of the tissue. Other possible but less common causes are Schatzki’s ring, a condition in which a benign circle of tissue forms around the esophagus; achalasia, a recurring and pronounced spasm of the lower esophageal muscle; and tumors.
The first step in the procedure is diagnostic: once the physician has determined that the esophagus is blocked or constricted, he or she must determine the cause of the blockage or stricture. Then he or she can choose from several different methods of performing the procedure. Most of them involve the breaking of the tissue which blocks the esophagus, and each of them has specific uses and benefits.
The fastest and simplest method involves the use of simple dilators, or bougies. These bougies are flexible tools of increasing thickness, which are passed through the esophagus one or more at a time. Simple bougie dilatation may be completed in the office, with the use of an anesthetic throat spray, and may take only a few minutes. The other methods are more involved, as they usually require endoscopy or X-ray control; but even these procedures usually take half an hour or less.
One such method involves the use of a guided wire bougie. In this method, the physician performs endoscopy (inserts a small optical device into the esophagus). He or she then runs a wire across the constricted portion of the esophagus, and passes dilators over the wire. At the end of the procedure, the wire is removed. Another method involves the use of balloon dilators: the physician again uses an endoscope, then passes balloon dilators through the flexible endocopic device. When the balloons are inflated, they break the stricture. Lastly, in cases involving achalasia, the physician often uses a special instrument known as an achalasia dilator to stretch and break the spastic muscles in the lower esophagus. This procedure is often performed with x-ray control. If x-ray equipment is needed, the procedure will normally take place in the x-ray unit. Recovery from all of these procedures is normally rapid, and the patient can begin eating and drinking again very shortly after the operation.
Last updated: 20-Jun-03