A dilator is a device used to stretch or to enlarge an opening. Dilatation procedure is usually indicated in patients with muscular tube scarring in the esophagus to ensure adequate passage of food and fluids. It involves the use of esophageal dilators. There are three common types of esophageal dilators namely esophageal dilator bougie, esophageal dilator mercury weighted bougies and pneumatic dilatation.
Indications
Dilators are indicated in a variety of medical conditions. It is specifically indicated commonly in esophageal conditions to address difficulty in swallowing. It is an endoscopic procedure that aims to enlarge the esophageal lumen to obtain better passage of foods and fluids.
Esophageal Dilation Bougies
Made of tungsten in silicon material, an esophageal dilation bougie has a hollow and flexible tube useful in the treatment of esophageal disorders such as narrowing of passage of the esophageal lumen such as stenosis and decreased distal esophagus motility. Other conditions that warrant the undertaking of an endoscopic procedure using esophageal dilation bougie are achalasia (spasm of the lower esophageal muscles), acid peptic strictures (there is acid reflux in the stomach), esophageal cancers (where tumors block the esophageal passageways) and schatzki rings (where lower esophagus is constricted with fibrous tissue.
Mercury Weighted Bougies
These are forms of bougies that are passed into the esophagus in increasing sizes in order to dilate the area where there is stenosis or obstruction. Maloney bougies is the most common type of mercury bougies.
Pneumatic or Balloon Dilators
During endoscopy or fluoroscopy, pneumatic dilators, also known as balloon dilators, are used in its deflated form to the site of narrowing and it is then inflated with air to a certain pressure that is preset to a specific circumference. It is the highly preferred dilation procedure done in achalasia where there is no cure for this condition and management goal is primarily to facilitate the esophageal emptying. The procedure usually employs a graded approach where dilation is initiated with small sized balloon that gradually incrementally increases in size when the symptoms persist.
Complications
While esophageal dilators are useful tools in the fluoroscopy or endoscopy procedures, they do pose the risks for complications. Among the common complication is vomiting of blood, a condition called hematemesis. It is also possible to experience painful swallowing or odynophagia. Esophageal dilators may also perforate and damage the esophageal linings or walls while one may also become susceptible to bacterial infections on the mediastenum called mediastinitis.
Warnings
Patients with unstable medical conditions like cardiac and respiratory problems need to secure from the physician a clearance before undergoing an esophageal dilatation procedure. Previous abdominal surgery is also contraindicated in patients who will undergo endoscopic dilatation.
