| Esophageal Dilatation
 The
esophagus is the long, narrow food tube (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 Blockage
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 which is a
visual exam of the esophagus using a flexible fiberoptic tube. 
Acid Peptic Stricture - This condition is very common. The stomach
produces acid which, in turn, can reflux into the esophagus. This event is
usually made worse 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.
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.
Ingestion of Caustic Agents - Children are particularly prone to
swallowing liquid lye and other agents which can severely burn the esophagus,
leaving it narrowed.
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.
Methods of Esophageal Dilatation
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 best
method of treatment. 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 time. The bougie is the simplest and quickest method of opening
the esophagus.
Guided Wire Bougie - In some instances, the physican performs
endoscopy and places a flexible wire across the stricture. The endoscope 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 exam, the wire is
removed. This type of treatment may be performed in the x-ray department under
fluoroscopy.
Balloon dilators - Flexible endoscopy allows the physician to
directly view the stricture. Deflated balloons are placed through the
endoscope 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-type dilator. The procedure is frequently 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.
The Procedure
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. If x-ray fluoroscopy equipment is needed, the procedure is
performed in the x-ray unit. 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.
Complications
Esophageal dilatation is usually performed effectively and without problems.
However, some complications can occur. A small amount of bleeding almost always
happens at the treatment site. At times, it can be excessive, requiring
evaluation and treatment. An uncommon but known complication is perforation of
the esophagus. The wall of the esophagus is thin and, despite the best efforts
of the physician, can tear. An operation may be required to correct this
problem.
Alternative Treatments
The alternative treatment options are to do nothing or to undergo major chest
surgery. The latter is recommended only if dilatation is ineffective.
Summary
Narrowing or stricture of the esophagus is a very common problem. The physician
can almost always uncover the specific cause of the stricture. And there are a
variety of treatment options available for the physician. Complications are rare
and, in most instances, a satisfactory outcome occurs with complete clearing of
or improvement in the swallowing problem.
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