Stricture Dilation

Stricture dilation – sometimes called dilatation – is a procedure to widen or stretch (dilate) abnormal narrowings (strictures) in the esophagus or other organs.

Stricture dilation is utilized for a variety of conditions, but most commonly for esophageal strictures. An esophageal stricture is a common finding in gastroenterology, and endoscopic esophageal dilation is the most commonly used procedure for treatment. Depending on the location and size of the stricture, your physician may use different types of rubber balloons (inflated with air or water) to dilate the esophagus and treat the stricture.

Disease Overview

An esophageal stricture is the scarring or narrowing of the esophagus due to reflux of stomach acid in individuals with heartburn.

The esophagus, also referred to as the food pipe, allows food and liquids to pass through it down to the stomach. Individuals with a narrowed section of the esophagus commonly have difficulty in swallowing, with a feeling of food “stuck” in the throat or chest area that causes pain or discomfort. Esophageal dilation is a procedure to help dilate or widen the narrowed or constricted section of the esophagus, allowing unhindered passage of food and liquids.

Indications

Stricture dilation is mainly recommended for the treatment of esophageal strictures that result from conditions, such as:

• Peptic ulcer disease
• Gastroesophageal reflux disease (GERD)
• Esophageal cancer
• Scarring after radiation treatment to the neck or chest
• Esophageal varices (enlarged veins in the esophagus)
• Hiatal hernia
• Schatzki's ring: A narrowing of the lower esophagus that can cause swallowing difficulty (dysphagia)
• A history of dysphagia
• Alcohol abuse
• Prolonged use of a nasogastric tube

Preparation

Preoperative preparation for stricture dilation may involve the following steps:

• A thorough history and physical examination
• Routine blood work and imaging
• Informing your doctor of any allergies to medications or anesthesia
• Informing your doctor of any medications or supplements you are taking or any conditions you have such as heart or lung disease
• Refraining from certain medications, such as blood thinners, aspirin, or NSAIDs
• Refraining from solids or liquids at least 8 hours prior to the procedure
• Arranging for someone to drive you home after the procedure

Procedure

Stricture dilation is most commonly performed using an endoscopic technique. An endoscope is a long, thin, flexible tube with a camera and light source at the end. Images from the camera are transmitted to a large monitor for your physician to view the inside of your esophagus. In general, the procedure involves the following steps:

• General or local anesthesia is administered to numb your throat. You may also be given sedation medication to keep you relaxed.
• Your physician then inserts an endoscope through your mouth into the esophagus. Fluoroscopy may be used to create a continuous X-ray image on a monitor throughout the procedure.
• The stricture areas are widened by the use of certain special instruments that are carefully inserted into your esophagus through your mouth. Different types of instruments can be used for this process including:
  • Balloon dilator: A tiny, deflated balloon is inserted into the area of stricture through the endoscope. The balloon is slowly inflated and later deflated when the stricture is widened enough.
  • Guided-wire dilator: A thin wire is carefully eased down into the area of the stricture. A small tube that is wider on one end is guided down the wire into the stricture to stretch it.
  • Bougies: These are cone-shaped, weighted tubes of different sizes that are inserted one after the other, in ascending order of size, until the stricture is expanded sufficiently.
• Once the procedure is complete, the scope and instruments are withdrawn and you are moved to the recovery room.
• The procedure takes about 30 minutes to complete.

Post Procedure care

Post-procedure care and instructions may involve the following:

• You will be transferred to the recovery area where your nurse will monitor your vital signs as you recover from the effects of anesthesia.
• It is normal for you to feel soreness in the throat from the endoscope.
• You will be given pain medicines and anti-nausea medications to relieve your pain and discomfort.
• You should be able to take liquids once the anesthetic wears off and you no longer feel numbness in your throat.
• You should be able to resume your normal diet the same day or the next day.
• A follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Stricture dilation is a relatively safe procedure; however, some risks and complications may occur, such as:

• Infection
• A hole or tear in the lining of the esophagus
• Adverse reactions to anesthesia
• Bleeding
• Sore throat
• Need for repeat/additional procedures

Summary

Stricture dilation is a minimally invasive treatment most commonly employed for the treatment of esophageal strictures. It is a safe procedure and serious complications are rarely noted. The procedure helps to resolve symptoms associated with the stricture to improve your quality of life.