Esophageal Dilatation

What you should know

• Esophageal dilatation is a procedure to widen the part of your esophagus that is too narrow. The esophagus is the soft tube that carries food and liquids from your throat to your stomach. Any injury or change in the esophagus tissue may cause it to have swelling and damage. When damaged areas heal, scar tissue can form to make the areas hard and stiff. Areas of scar tissue can cause the esophagus to become narrow. Food, and sometimes liquids, may have a hard time passing through the narrow part of the esophagus. Injuries may be caused by long-standing reflux disease, infections, surgery, radiation treatment, or swallowing chemicals or foreign bodies. A tumor (growth) inside or near the esophagus, and diseases of the esophageal muscles may also cause narrowing.
  
  
• An endoscopy exam of the esophagus and stomach (EGD) may be done before or during the dilatation procedure. This is done with an endoscope, which is a bendable tube that has a light and camera on its end. Esophageal dilatation is done using one of three types of dilators. A balloon dilator may be passed through the endoscope during the exam and then inflated in the esophagus. A rigid or bougie dilator is passed through your mouth without the endoscope until it reaches the narrowing. Bougies are dilators made of soft rubber and filled with metal to make them heavy. Rigid dilators are made of hard plastic and positioned using a guide wire passed through the endoscope. Your caregiver may use fluoroscopy (special type of x-ray) to guide him during the procedure. Usually no more than three dilators of increasing sizes are passed in a single procedure. Having an esophageal dilatation will help relieve your problems with swallowing food.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

You may get too much sedation or have an allergic reaction to the medicine. This may cause you to have trouble breathing. Some of your saliva or stomach fluids may get into your lungs and cause pneumonia. Your esophagus may get damaged from the procedure, and cause infection or bleeding. If you have a large injury or too much bleeding, you may need surgery to fix it. Even with a successful procedure, your esophagus may again get narrow. This may mean having the procedure done again or repeated many times, or you may need surgery. Call your caregiver if you are worried or have questions about your procedure, medicine, or care.

Getting Ready

The week before your procedure:

• Ask a family member or friend to drive you home after the procedure. Do not drive yourself home.
  
  
• Tell your caregiver if you know or think you might be pregnant.
  
  
• Tell your caregiver if you are taking blood thinner medicines. They may need to be stopped for a while before you have the procedure.
  
  
• Tell your caregiver if you have bleeding problems, or problems with your throat or neck. Also tell if you have a lung or heart disease. Tell your caregiver if you have had a tear in your esophagus.
  
  
• You may need to have a barium swallow exam done before your procedure. You need to drink a thick liquid called barium during this exam. This liquid helps your esophagus and stomach show up better on x-rays. You may also need an endoscopy, contrast x-ray, computed tomography (CT) scan, or ultrasound. Ask your caregiver for more information on these tests that you may need. Write down the date, time, and location of each test.

The night before your procedure:

• If you have diabetes, ask your caregiver for special instructions about what you may eat and drink before your surgery. If you use medicine to treat diabetes, your caregiver may have special instructions about using it before surgery. You may need to check your blood sugar more often before and after having surgery.
  
  

The day of your procedure:

• Write down the correct date, time, and location of your procedure.
  
  
• Ask caregivers about directions for eating and drinking.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
  • Antibiotic medicine may be given to those who are at risk of getting an infection from germs. This medicine is given right before your procedure.
    
    
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.

Treatment

What will happen:

• You will be taken to an endoscopy room. Your caregiver may spray anesthesia medicine to your mouth to make your throat numb. You will most likely get conscious sedation (short acting, light sedation) during your procedure. Oxygen may be given through a nasal cannula (a pair of short, thin tubes resting inside your nose). You will seat in a chair or lie down on your left side on a special table. Your caregiver will place a plastic guard in your mouth to protect your teeth. When you become sleepy from the sedation, endoscopy may be done before or while doing the procedure. Your caregivers will monitor your heart rate, breathing, blood pressure, oxygenation, and level of sedation.
  
  
• The endoscope or dilator will be passed through your mouth down into the narrowed part of your esophagus. A biopsy (tissue sample) may be taken and sent to lab for tests before the dilation. Fluoroscopy may be done to check if the dilator or guide wire is in the right place. Dilation is done with the dilator or balloon in place for 1 to 2 minutes. This may be repeated once or twice with larger dilators. The endoscope may be inserted again to place a stent (tube to hold the esophagus open). A shot of steroid medicine may also be given to help prevent the area from getting narrow again. The dilator and endoscope will be removed carefully.

After your procedure:

You may lie in bed and rest while you wake up from the sedation. Caregivers will continue to monitor your vital signs. You may be allowed to drink water after your procedure. When your caregiver sees that you are OK, you will be allowed to change clothes and go home. If your caregiver wants you to stay in the hospital, you will be brought to your hospital room.

Contact a caregiver if

• You cannot make it to your procedure on time.
  
  
• You get sick (a cold or flu) or have a fever.

Seek Care Immediately if

• You have more trouble swallowing.
  
  
• You are losing weight without trying to do so.
  
  
• You have food stuck in your throat that will not move.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Esophageal Dilatation (Precare)