Esophageal dilatation is a therapeutic endoscopic

Endoscopy

Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an endoscope , an instrument used to examine the interior of a hollow organ or cavity of the body. Unlike most other medical imaging devices, endoscopes are inserted directly into the organ...

 procedure that enlarges the lumen

Lumen (anatomy)

A lumen in biology is the inside space of a tubular structure, such as an artery or intestine...

 of the esophagus

Esophagus

The esophagus is an organ in vertebrates which consists of a muscular tube through which food passes from the pharynx to the stomach. During swallowing, food passes from the mouth through the pharynx into the esophagus and travels via peristalsis to the stomach...

.

Indications

It can be used to treat a number of medical conditions that result in narrowing of the esophageal lumen, or decrease motility in the distal esophagus. These include the following:

• Peptic stricture
  Esophageal stricture
  Benign esophageal stricture is a narrowing or tightening of the esophagus that causes swallowing difficulties.-Causes:It can be caused by or associated with gastroesophageal reflux disease, esophagitis , dysfunctional lower esophageal sphincter, disordered motility, lye ingestion, or a hiatal hernia...
  
  
• Schatzki ring
  Schatzki ring
  A Schatzki ring or Schatzki-Gary ring is a narrowing of the lower part of the esophagus that can cause difficulty swallowing. The narrowing is caused by a ring of mucosal tissue or muscular tissue. Patients with Schatzki rings can develop intermittent dysphagia , or, more seriously, a completely...
  
  s
• Achalasia
  Achalasia
  Achalasia , also known as esophageal achalasia, achalasia cardiae, cardiospasm, and esophageal aperistalsis, is an esophageal motility disorder involving the smooth muscle layer of the esophagus and the lower esophageal sphincter...
  
  
• Scleroderma
  Scleroderma
  Systemic sclerosis or systemic scleroderma is a systemic autoimmune disease or systemic connective tissue disease that is a subtype of scleroderma.-Skin symptoms:...
  
   esophagus
• Rarely esophageal cancer
  Esophageal cancer
  Esophageal cancer is malignancy of the esophagus. There are various subtypes, primarily squamous cell cancer and adenocarcinoma . Squamous cell cancer arises from the cells that line the upper part of the esophagus...
  
  

Types of dilators

There are three major classes of dilators:

• Mercury weighted bougies are blindly inserted bougies placed into the esophagus by the treating physician
  Physician
  A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
  
  . They are passed in sequentially increasing sizes to dilate the obstructed area. They must be used with precaution in patients with narrow strictures, as they may curl proximal to the obstruction. The most commonly used mercury weighted bougies are the Maloney bougie dilators.
• Bougie over guidewire dilators are used at the time of gastroscopy
  Esophagogastroduodenoscopy
  For other expansions of the initialism "OGD", see the disambiguation page.In medicine , esophagogastroduodenoscopy is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract up to the duodenum...
  
   or fluoroscopy
  Fluoroscopy
  Fluoroscopy is an imaging technique commonly used by physicians to obtain real-time moving images of the internal structures of a patient through the use of a fluoroscope. In its simplest form, a fluoroscope consists of an X-ray source and fluorescent screen between which a patient is placed...
  
  . An endoscopy
  Endoscopy
  Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an endoscope , an instrument used to examine the interior of a hollow organ or cavity of the body. Unlike most other medical imaging devices, endoscopes are inserted directly into the organ...
  
   is usually performed first to evaluate the anatomy, and a guidewire is passed into the stomach
  Stomach
  The stomach is a muscular, hollow, dilated part of the alimentary canal which functions as an important organ of the digestive tract in some animals, including vertebrates, echinoderms, insects , and molluscs. It is involved in the second phase of digestion, following mastication .The stomach is...
  
   past the obstruction. This may also be done fluoroscopically. Bougies are again introduced—this time over the guidewire—in sequentially increasing sizes. The most commonly used bougie over guidewire dilators are the Savary or Savary-Gilliard dilators.
• Pneumatic dilatation or balloon dilatation is also typically done at the time of endoscopy or fluoroscopy. A balloon is inserted in the deflated form into the area of narrowing. It is then inflated with air to a certain pressure that is pre-set for a given circumference.

Complications

Complications of esophageal dilatation include the following:

• odynophagia
  Odynophagia
  Odynophagia is painful swallowing, in the mouth or esophagus. It can occur with or without dysphagia, or difficult swallowing....
  
  , or painful swallowing
• hematemesis
  Hematemesis
  Hematemesis or haematemesis is the vomiting of blood. The source is generally the upper gastrointestinal tract. Patients can easily confuse it with hemoptysis , although the latter is more common.-Signs:...
  
  , or bloody vomit
• esophageal perforation
  Boerhaave syndrome
  Esophageal rupture is rupture of the esophageal wall due to vomiting. 56% of esophageal perforations are iatrogenic, usually due to medical instrumentation such as an endoscopy or paraesophageal surgery...
  
  
• mediastinitis
  Mediastinitis
  Mediastinitis is inflammation of the tissues in the mid-chest, or mediastinum. It can be either acute or chronic.Acute mediastinitis is usually bacterial and due to rupture of organs in the mediastinum. As the infection can progress rapidly, this is considered a serious condition...