Esophageal dilation

Considerations

• • Anatomy 

  • Indications

  • Contraindications 

  • Special patient group - Head and neck cancer

  • 2010: Timing of esophageal dilation for dysphagia in head and neck cancer patients receiving radiation therapy

  • Technique

  • 2002: A review of endoscopic methods of esophageal dilation

  • 2008: Esophageal and pharyngeal strictures: report on 1,862 endoscopic dilatations using the Savary-Gilliard technique

  • 2009: Transnasal balloon dilation of the esophagus

  • 2011: Endoscopic management of difficult or recurrent esophageal strictures

Preparation

• • Thermasplint and hot water and ice

  • GI plastic mouth guard 

  • Maloney dilators (conical)

  • Straight bougies

  • Cook Hercules balloon dilators 

  • GI flexible esophagoscope and tower 

    • Requires two hands to operate 

    • Practice using the controls - insufflation with and without water, suction, up / down. left / right

Procedure

Sample operative report

Post-op

• • Complications

  • 2015: Full-thickness esophageal perforation after fluoroscopic balloon dilation: incidence and management in 820 adult patients

  • 2016: Cervical Spine Spondylodiscitis After Esophageal Dilation in Patients With a History of Laryngectomy or Pharyngectomy and Pharyngeal Irradiation

    • • "In patients with a history of laryngopharyngeal irradiation and esophageal dilation, complaints of neck pain or upper extremity weakness should trigger immediate evaluation for CSS; if present, prompt therapy is essential for prevention of substantial morbidity and mortality."

Pearls & Pitfalls

High-Yield

Links

• UTMB Grand Rounds - Esophagology and Esophagoscopy