Endoscopic oesophageal dilation opens a narrowed segment of the oesophagus that is obstructing the passage of food, using instruments passed through the endoscope or over a guidewire: graduated cylindrical dilators of increasing diameter pushed gently through the stricture, or a balloon positioned within it and inflated step by step to widen the wall from inside. It is performed under intravenous sedation with direct vision, and fluoroscopy may be used for complex strictures. The commonest causes of a stricture requiring dilation are scarring from chronic acid reflux, a fibrous ring in the lower oesophagus, narrowing after surgery or radiotherapy, stricture following ingestion of a caustic substance, and some disorders of relaxation of the lower oesophageal muscle. The typical symptom is difficulty swallowing that begins with solid food and progresses, often with food impaction, regurgitation and weight loss. The limits must be stated openly: dilation opens the passage but does not remove the cause. If acid reflux created the stricture, the narrowing will recur unless the reflux is treated consistently, which is why acid-suppressing therapy after dilation is part of the treatment rather than an optional add-on. Strictures frequently need several sessions with gradually increasing diameter rather than one aggressive dilation, and that is deliberate, to reduce the risk of a tear. Dilation does not treat swallowing difficulty caused by general neurological or muscular disease, and it does not resolve obstruction from a tumour without a plan to treat the tumour itself. Complications are uncommon but should be named honestly: a tear or perforation of the oesophageal wall, bleeding, and transient chest pain. Perforation is the most serious because it needs prompt intervention, which is why gradual dilation is the rule and why you are observed after the procedure before being allowed home. Whether to dilate, by which technique, to what diameter and over how many sessions are all decided by clinical assessment, by what is seen during endoscopy, and by biopsy results where taken. Taking a biopsy from the stricture is a routine step to confirm its nature before dilation alone is accepted as treatment.
Procedure steps
- 1
Assessing the swallowing difficulty
The nature of the complaint is reviewed: whether difficulty affects solids only or liquids too, how long it has been present, and whether there is weight loss, reflux or pain. A barium study or oesophageal motility testing may be requested first.
- 2
Endoscopy and defining the stricture
The scope is introduced under sedation and the level, length, severity and appearance of the stricture are assessed, with biopsies taken where needed to confirm its nature before dilation, a step that guards against dilating a narrowing that requires different treatment.
- 3
Graduated dilation
A guidewire is passed or a balloon is positioned within the stricture, and dilation proceeds gently through increasing diameters within the session, stopping at the safe limit. The principle is measured dilation, not maximum dilation.
- 4
Re-inspection and assessing the result
The scope is reinserted to assess the dilated segment: whether it now passes easily, whether there is expected superficial splitting rather than a tear requiring intervention, and whether any bleeding needs treatment before the session ends.
- 5
Observation, session plan and medical therapy
You are observed after waking for chest pain or fever and try fluids before discharge. Further dilation sessions are then scheduled if required, and reflux treatment is prescribed because it is what prevents the stricture from returning.
Before the procedure
Fasting from food and fluids for the period the unit specifies is mandatory, and a longer fast may be required if food is being held up above the stricture, so that nothing can enter the lungs during sedation; clear fluids only on the preceding day are often advised for tight strictures. Tell your doctor about all your medicines, especially blood thinners, anticoagulants, diabetes drugs and acid suppressants, and report any past ingestion of a caustic substance or previous surgery or radiotherapy to the chest or neck, as these change the dilation plan. Mention drug allergies, heart or lung disease, a heart valve, a pacemaker, and pregnancy. Remove dentures before entering the room. Arrange an adult escort to take you home, because driving is not allowed after sedation, and do not plan work or travel for the same day.
After the procedure
Mild chest or throat discomfort and some soreness on swallowing are normal on the first day and ease gradually. Start with lukewarm fluids once the team allows, then move to soft food for several days, avoiding dry bread, crisp foods and large pieces of meat, chewing well and drinking with meals. Seek emergency care immediately for severe, persistent or increasing chest pain, pain that worsens rather than eases on swallowing, breathlessness, fever and chills, a racing pulse, swelling or crackling under the skin of the neck, or vomiting blood or black stools. These suggest a tear, perforation or bleeding; they are uncommon, but perforation is the most serious and needs prompt intervention. Do not drive or sign important documents on the day of sedation and do not spend that night alone. Take the reflux treatment your doctor prescribes consistently, because it is what reduces the chance of the stricture returning, and attend your follow-up dilation sessions as scheduled.
Expected duration
Usually 15 to 40 minutes per session, plus one to two hours of recovery and observation before discharge.
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