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Esophageal dilatation


Medical editor Trond Warloe MD
Surgeon
Oslo University Hospital

General

Esophageal dilatation is for patients who have undergone an esophagus resection where anastomosis is made between the remainder of the esophagus and stomach. Scar tissue around the anastomosis often leads to a shrinking in the passage making it painful to swallow. 

Dilatation is usually performed 6 weeks after the operation and it is common to repeat the procedure 6-8 times.

The procedure is carried out using a gastroscope, which is a flexible tube equipped with a camera on the end, light system, and one or two work canals. Using this, the mucosa can be inspected and the images are transferred to a monitor.

Indications

  • Postoperative narrowing of the surgical anastomosis
  • Routine procedure following esophageal resection 

Goal

  • Enlarge space in the esophagus

Equipment

  • Gastroscope with accessories
  • Equipment for unblocking (esophageal balloon, dilator, pistol)

Preparation

The patient must:
  • Inform the health personnel if he/she is aware of a valve defect in their heart. In this case, an endocarditis prophylactic is given.
  • Inform the health personnel if he/she is being treated with insulin.
  • Inform the health personnel if he/she is being treated with an anticoagulant or arthritis medication. This should not be taken for 5 days prior to the examination.
Before the examination:
  • The patient must fast for 6 hours before the examination. Clear fluids are allowed for up to the last 2 hours before the examination.  
  • Medications may be taken the same day with a sip of water.
Examination day:
  • A premedication is given.
  • The patient lies on their left side on the examination table.
  • Dental prosthetics must be removed before the examination.
  • Before the examination, a local anesthetic is sprayed in the throat. This will work for about 30 minutes.

Implementation

  • Sedative and pain medication is given.
  • The gastroscope is inserted through the mouth, down the esophagus, and to the constriction/anastomosis.
  • Air is blown in to rinse the esophagus/stomach to obtain better overview during insertion of the scope.
  • A dilatation balloon is inserted down the esophagus through a canal in the gastroscope.
  • The balloon is placed in the middle of the constriction.
  • When the balloon is filled with water under pressure, the tissue is stretched. The pressure remains for about 3 minutes.
  • The balloon is emptied and retrieved together with the gastroscope.

The procedure usually lasts 10–30 minutes.


Follow-Up

Pain and tendency for vomiting, pressure, and bloating are normal discomforts during/immediately following the exam.

The patient should be observed for: 

  • Intense pain, vomiting blood. In rare circumstances, the tissue splits and air seeps out into the mediastinum and moves around in the corium of the throat (crepitation). If the patient has returned home, he/she must contact the hospital directly for X-ray of the thorax.
  • Bleeding if a biopsy is taken or polyps are removed.

The patient may eat/drink at the earliest 1 hour after the procedure due to the local anesthesia in the throat. For outpatient procedures, the patient may return home after 2-4 hours.


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