Dilation of the esophagus
Dilation of the esophagus can be done in two ways:
A balloon is introduced into the narrowed part of the esophagus and inflated to a certain pressure and volume, with consequent dilation of the organ;
Entering the restricted zone, probes of increasing caliber (the dilators) which exert a progressive dilation of the organ. The choice of one or the othertechnique depends on the characteristics and location of the stenosis. Both methods are performed during gastroscopy, examinationwhich allows you to visualize the esophagus, stomach and duodenum and assess the presence and length of any narrow sections.
How will I be prepared for the exam?
To perform the dilation, it is necessary that you have not eaten for at least 12 hours. In addition, some surveys will be conductedthey will inform you about your state of health (blood tests, electrocardiogram). They will be given to you during the exam.drugs which, without putting him to sleep, will help him to bear the examination easily. Type of medication and intensity of sedationwill be decided at the time of the examination according to its clinical characteristics. The duration of the examination is very variable and in all casesunpredictable: usually lasts 10 to 30 minutes. During the examination, you will feel pain and swelling caused by the advancement of thegastroscope into the organ and by the dilation of the stenosis. At the end of the exam, he may remain dizzy for a while due to the medicationhave been given to you and you may feel mild pain in your chest and abdomen for a few hours.
What are the risks of dilation?
Dilation of the esophagus is an essentially safe procedure but, as with allmedical acts, can give rise to complications. The arm where the cannula was placed may become red and swollenwhich disappear, usually spontaneously, within a few days. Other risks arise from the use of sedatives in elderly patients orwith severe cardiorespiratory disease. Therefore, answer carefully the questions we ask you about allergies and diseases offrom which he suffers.
The most serious complications of endoscopic treatment of colonic strictures are represented by perforation and hemorrhage,occurring in approximately 1-2% of patients. Both can be treated with medical therapy or endoscopy; in some casessurgery may be needed to close the perforation and clear the abdominal and chest cavitiesleaked material. If complications arise, surgery will be performed.stricture dilation was initially to be avoided. Other possible complications are pain and fever. It's insidetype, of benign complications which heal quickly with the administration of drugs. Despite the aforementioned complications, theEsophageal dilation is the easiest and safest way to resolve a stricture of the esophagus. The alternative to dilation issurgery, more risky and boring. In the majority of cases the dilation of the stenosis is effectivedefinitive. In some patients, after a more or less long and in any case unpredictable period of time, the dilated tract may shrinkAgain. In this case, we will evaluate whether to submit it to a new dilation or to an alternative treatment.
How to perform esophageal dilation?
Before starting the procedure, vital parameters are detected (heart rate, saturation ofoxygen and blood pressure).Before starting the examination, it is advisable to inform the doctor if you have any allergies or if you are undergoing treatmenthabits and if you have a pacemaker or other implantable device that may interfere withelectromedical tools.If the patient wears a removable dental prosthesis, this must be reported and removed beforebegin.The gastroscopy will be performed under deep sedation with anesthetic assistance and beforeof the investigation a vein in the arm will be cannulated which will allow the administration of the drugsedative. The anesthesiologist will provide you with further information on this and ask for your specific consent.The patient is placed on the left side in a comfortable position, aaccessory called a mouthpiece to keep your mouth open then during the examination the doctor will introduce youthe endoscope through the mouth and throat until it narrows.
To perform the dilation, either a balloon catheter with manometer can be used(pressure) or polyvinyl dilators in the shape of a "candlestick" of increasing caliber called Savary dilators.
If the balloon catheter is used, after placing a guide wire, it is insertedinside the endoscope, it is introduced into the constricted section, the balloon is then inflated untilObtain adequate pressure to dilate the stricture.The entire maneuver is performed under endoscopic and/or radioscopic visual control.
If Savary dilators are used, always after placing a guide wire in the tractrestricted, dilators of increasing caliber are gradually introduced under radiological control, until obtainingadequate dilation of the stenosis.
Since the procedure involves the use of X-rays, which can harm the fetus, all women of agefertile must be absolutely certain that she is not pregnant; for this purpose apregnancy test. It is necessary to communicate whether breastfeeding is in progress.
These maneuvers are performed under deep sedation with the help of the anesthesiologist, on a regular basisoutpatient or ordinary hospitalization or day hospital/day surgery depending on the clinical picture.The anesthesiologist will provide you with further information on this and ask for your specific consent.
At the end of the examination, chest pain may be felt which usually disappears with the use ofpainkillers.
To achieve effective dilation of the esophageal lumen, in some cases it is necessary to repeat the procedurefor a few sessions.
Possible recovery issues
If the examination is performed under sedation, sedoanalgesia or deep sedation, For your safety, within 24hours after the examination, he must refrain from driving vehicles and professional/sporting activities involvingspecial attention and which may lead to risks or accidents in the event of dizziness, lack ofattention or motor coordination; it is also advisable to avoid making important decisions.
The resumption of oral nutrition provides for the gradual and progressive increase in the consistency of food(refer to the post-intervention rules and the indications of the doctor who performed the intervention).Taking psychoactive or sedative drugs should be agreed with your doctor.After 24 hours, you will only be able to perform any type of activity if you feel well.