What is oesophageal dilation?
This is where your oesophagus is stretched (dilated) to improve your swallowing. The procedure is usually very straightforward. It will initially involve an endoscopy (gastroscopy) to look at the areas of narrowing (see gastroscopy leaflet).
What are benefits of oesophageal dilation?
The aim of dilation is to improve your swallowing. This may involve more than one dilatation over several appointments depending on how much stretching up your gullet will require.
Your Procedure Explained
A gastroscopy is carried out using a long flexible instrument called an endoscope. (See gastroscopy leaflet).This is about the thickness of your index finger with a bright light at one end. The endoscope is placed into your mouth and guided into your gullet and if necessary your stomach and duodenum. The procedure is usually carried out under x-ray control. The narrowed area of the gullet will be identified and a balloon will be passed across it through the endoscope. The balloon is inflated to stretch the narrowing. The balloon can be inflated and deflated to certain pressures within the narrowed area and as the balloon expands the oesophagus also is stretched to reach the diameter of the balloon. Different sizes of balloons can be used in order to safely stretch the oesophagus to the diameter required to improve your symptoms.
What are the risks?
As with all medical procedures there are some risks involved. The main risk of this procedure is creating a leak (perforation) through the gullet or stomach. The risk of perforation depends on the nature of the narrowing. It is usually less than 1%, the doctor performing your test will discuss your individual risk with you before your test. If a perforation occurs, an operation to repair the leak may be needed.
Other complications include risk of bleeding; this can occur from where a biopsy has been taken which occurs in about 1 in every 150 procedures. The risk of bleeding requiring a blood transfusion is less than 1in 500.
Damage to teeth or crowns is possible although rare. In addition it is not always possible to complete the procedure, this may be because you are unable to swallow the tube or you have asked us to stop.
You should be aware that no test is 100% accurate and abnormalities can be missed, including cancers. You may wish to discuss this with the doctor/nurse who will seek your consent before the examination.
The procedure is usually performed under sedation. There is a small risk that the sedative may affect your breathing. We aim to reduce this risk by assessing your general health before the endoscopy and you will be closely monitored by qualified nurses before and after the examination.
The Medications You May Receive
Local anaesthetic throat spray
The spray numbs the back of your throat to make it more comfortable to swallow the tube. You will be fully awake whilst the test is being performed. We will take you to recovery to monitor you for a short while to rest and recover. You can drive yourself home and carry on with your usual activities. You will not be able to eat or drink for 1½ hours after the test, until you can swallow as normal.
Midazolam and Fentanyl
Midazolam is a sedative injection which aims to make you feel relaxed and fentanyl is a painkiller. They are given through a small needle in your arm or hand once you are in the procedure room before the test begins. Both of these treatments can affect your mental ability to think clearly for up to 24 hours after they are given, even though you may feel wide awake. If you have sedation and painkiller you must have someone to collect you from the endoscopy department and stay with you for the next 24 hours. We will not be able to give you any sedation if you do not have a responsible adult to collect you and stay with you for 24 hours.
For 24 hours after the procedure you should not do any of the following:
- Drive a vehicle or motorbike
- Use kitchen appliances such as a cooker
- Have a bath unsupervised
- Look after children on your own
- Go to work
- Operate any potentially dangerous machinery
- Sign any legal documents
- Drink any alcohol
- Take sleeping tablets or recreational drugs
- Breastfeeding
What should I do before my procedure?
Your regular medication should be taken as normal before your test unless you have been advised otherwise by a health care professional.
If you have diabetes you should not take your diabetic medication whilst you are not eating food.
An endoscopy nurse will either see you in preassessment clinic or telephone you before your test, especially if you are taking diabetic medication, warfarin or clopidogrel tablets.
On The Day Of Your Procedure
To allow a clear view of your stomach it must be empty:
- Do not have any solid food for 6 hours before your test
- You may have clear fluids (no milk) up to 2 hours before your test
- If you are attending for an appointment after 5pm you must not have solid food 10 hours before your test
It is important that you do not starve for longer than this, unless specifically advised by the doctor / nurse, to avoid dehydration.
On arrival in the endoscopy department, please give your name to the receptionist. Your appointment time is the booking in time, not your procedure time. We will try to start your procedure as soon as possible. You may wish to bring a book, newspaper or magazine to read as you wait. Delays can occur, this is mainly due to clinical reasons including emergency situations. We will try to keep you updated with any delays in the unit.
Before the test, you will be seen by a nurse who will go through the health questionnaire with you. A doctor will speak to you in a private area of the department before your procedure. This will give you the opportunity to ask any questions. You will then be asked to sign a consent form indicating you understand the nature and risks of the procedure. You are not required to change out of your usual clothing.
What should I expect during the procedure?
The nurse caring for you during the test will ask you to lie on your left-hand side on a trolley. If you have spectacles, hearing aids or dentures you will be asked to remove them for the test. Oxygen will be given to you by a small tube into your nose and a small plastic mouth guard will be placed in your mouth. A nurse will monitor your pulse rate and oxygen levels during the test. During the test air is used to inflate your gullet and stomach to allow a clear view. The air is sucked out at the end of the test; however, you may get “windy” type symptoms and a sore throat. This will usually pass within 24 hours. You may also feel a slight discomfort when the balloon is expending within the gullet, this is short lived. If you get a lot of saliva in your mouth, the nurse will clear it using a sucker. The test takes approximately 15-30 minutes.
Does it hurt and will I be in much pain?
The examination may result in some abdominal discomfort due to the stomach being inflated with air. This discomfort should begin to settle once the procedure is finished.
After The Examination
We will take you into our recover area to rest after your procedure where a qualified nurse will observe you until the main effects of the sedation have worn off. You may then be transferred to a ward for further observation before you go home, if not we will keep you in the Endoscopy recovery area. A chest x-ray may be required after your procedure and you will be nil by mouth until this has been done.
If you are going home the same day, please arrange for a friend or relative to collect you and stay with you for 24 hours as the effect of the sedation may make you sleepy or forgetful.
How will I know the results of my test?
The doctor or nurse endoscopist performing the procedure will often be able to give you some results after the procedure. Before you are discharged you will be given clear details concerning any follow up arrangements. A full report will be sent to your referring consultant.
Contact numbers
If you have any further questions, you should contact the following:
Queen Elizabeth Hospital (main switch) 0191 482 0000
Out of hours
Accident and Emergency 0191 445 2171
