The esophagus is the long, narrow food pipe (gullet) that
carries food and liquid from the mouth to the stomach. It can become blocked
or injured in a variety of ways. Esophageal dilatation is the technique
used to stretch or open the blocked portion of the esophagus.
CAUSES OF ESOPHAGEAL OBSTRUCTION
There are several causes of blockage or stricture of the
esophagus. They all can make swallowing food and/or fluids difficult.
The physician's first job is to find the reason for the stricture or narrowing.
The answer can usually be provided by the medical history, physical exam,
x-rays, and endoscopy (a visual exam of the esophagus using a flexible
» Acid Peptic Stricture - This condition is the most
common of all. The stomach produces acid which, in turn, can reflux into
the esophagus. This event is frequently worsened by the presence of a
hiatus hernia. Over time, the acid and peptic stomach juices injure the
esophagus, causing inflammation and then scarring. The fibrous scar then
contracts and - narrows the esophageal opening.
» Schatzki's Ring - This condition is really exactly
that, a narrow ring of benign fibrous tissue constricting the lower esophagus.
Physicians still do not know how it develops.
» Ingestion of Caustic Agents - Children are particularly
prone to swallowing liquid lye and other agents which can severely bum
the esophagus, leaving it narrowed.
» Achalasia - This condition is uncommon and quite
fascinating to physicians. The problem is a persistent and marked spasm
of the lower esophageal muscle. This spasm just does not open up to allow
food and fluid through. The result is a persistent blockage with subsequent
slow trickling of the esophageal contents into the stomach.
» Tumors - Various forms of tumors, benign and malignant,
can block the esophagus. This condition is obviously very important to
diagnose and treat promptly.
» Heredity - The esophagus may be partially or completely
blocked at birth.
In most instances, the problem is a mechanical one with
an obstruction acting like a dam across a stream. Therefore, the treatment
must be mechanical. The dam must be broken. After a diagnosis is made,
the physician determines the method of treatment that is in the patient's
best interest. The physician has a variety of techniques available. Each
has benefits and is appropriate in specific cases. The physician will
always discuss these options with the patient.
» Simple Dilators (Bougies) - These are a series of
flexible dilators of increasing thickness. One or more of these are passed
down through the esophagus at a setting. The bougie is the simplest and
quickest method of opening esophagus.
» Guided Wire Bougie - In some instances, physician
performs endoscopy and places a flexible wire across the stricture. The
scope is removed and the wire left in place. A dilator with a hole through
it from end to end is guided down the esophagus and across the stricture.
One or more of these dilators are passed over the wire. At the end of
the procedure the wire is removed. This type of treatment may be performed
in the endoscopy department under fluoroscope.
» Balloon Dilators - Flexible endoscopy allot the
physician to directly view the stricture Deflated balloons are placed
through the scope and across the stricture. When inflated they become
sausage shaped, stretch, and break the stricture.
» Achalasia Dilators - Achalasia is a special situation
which requires a larger balloon dilator. The procedure is always done
under x-ray control. In this situation, the spastic muscle fibers in the
lower esophagus are stretched and broken, which in turn allows easier
passage of food and liquid into the stomach.
As mentioned, there are a number of dilating techniques
available to the physician. Simple bougie dilatation may be done in the
office, in a sitting position, and with only an anesthetic spray of the
throat. If endoscopy is performed at the same time, then it will be done
in the endoscopy suite, usually under sedation. X-ray fluoroscope equipment
may be needed. Simple bougie dilatation may take only a few minutes. The
other techniques require 20 to 30 minutes. Recovery is usually quick and
the patient can soon begin eating and drinking to test the effectiveness
of the treatment.
RISKS OF PROCEDURE