Esophageal Dilation

9

1. Diagnosis
2. Treatment and Process
3. Stenoplasty
4. Complications

The esophagus is a long, narrow tube that carries food and liquids from the mouth to the stomach.

Esophageal dilation is the technique used to stretch a blocked or narrowed part of the esophagus. This procedure is used when a part of the esophagus has become so narrow that it becomes difficult, or even impossible and painful to swallow.

Dilation makes the passage of food and water into the stomach easier. This is usually a simple form of treatment but if it is not successful, surgery may be necessary. Surgery is a much more extensive form of treatment, with a longer recovery time.

Some of the most common causes of obstruction or narrowing of the esophagus are:

• Inflammation of the lower part of the esophagus. This usually happens due to constant exposure of the lower part of the esophagus to acid that returns from the stomach. Over time, this causes scarring and narrowing of the lower esophagus.
• Schatzki’s ring is a thin benign (non-cancerous) ring of fibrous tissue that constricts the lower esophagus. The reason for this is not well known.
• Achalasia is a change in the innervation of the end part of the esophagus and the lower esophageal sphincter. The lower esophageal sphincter is a muscle between the esophagus and the stomach that relaxes to allow food to pass into the stomach. After letting the food pass, it contracts to keep the food in the stomach. This change in innervation can be congenital (present since birth) or acquired by Chagas disease. This can cause irregular contractions of the lower esophageal muscle making the sphincter not open and thus not allowing food and liquids to pass. The result is a persistent blockage of the passage of esophageal content into the stomach.
• Stenoses can occur from ingesting substances that damage the esophagus. Some examples are acids or bases, such as caustic soda.
• Tumors, whether benign (non-cancerous) and malignant (cancerous) can also block the esophagus.

Diagnosis

Your doctor often suspects this problem through clinical history. He can prove his suspicion using X-rays and mainly endoscopy.

Treatment and Process

Esophageal stenosis is generally a mechanical problem, which can be treated with stretching (dilation). This can be done in different ways.

Flexible dilators: a series of graduated probes (increasing thickness) called thermoplastic probes can be used. These are tubes that pass through the esophagus to the stomach. The tubes used become progressively larger, until the desired size is reached.

Dilating balloons: esophageal dilation can be done using balloons during endoscopy. Flexible endoscopy allows the examiner to directly visualize the stenosis. A balloon is introduced through the device’s channel to the narrowing zone. It is then inflated with water to a certain pressure, which is pre-set for a given circumference. When inflated, it becomes sausage-shaped, stretched, and causes the stenosis to open.

Treatment of Achalasia

Achalasia requires a specific type of balloon, longer and larger, called a pneumatic balloon. In this situation, the spastic muscle fibers in the lower part of the esophagus are stretched.

In some cases of achalasia, treatment with botulinum toxin (botox) injection can be attempted.

In cases of achalasia that do not improve with endoscopic dilations, surgical treatment is indicated through a procedure called myotomy.

Stenoplasty

On some occasions, the narrowing (stenosis) is so great that even the dilation instruments cannot pass. In these cases and in some other situations, the stenoplasty procedure is performed. This consists of making small cuts in the region of the stenosis with the help of a stylet that is passed through the working channel of the endoscope. These small cuts help open the narrowing, facilitating the passage of the dilators and accelerating the treatment process. In some cases, after making the small cuts, some substances, such as corticosteroids, are injected into the region to prevent the narrowing from closing again easily.

Complications

Esophageal dilation is usually performed effectively and without problems. Some complications that may occur are:

A small amount of bleeding almost always occurs when dilation is performed. If this bleeding is excessive, it may require more aggressive treatment.

Another complication is perforation (hole in the organ wall). If this happens, an operation may be necessary to repair the problem.

Rarely, a small perforation can lead to infection, which can remain localized or even spread to neighboring organs.