Gastroenterology - A guide to having an Endoscopic Dilatation

You have been advised by your doctor that you could have a narrowing (stricture), an outlet that is failing to open in your gastrointestinal tract that may need to be stretched to improve your symptoms. This procedure is called a dilatation.

The narrowing can be in the upper gastrointestinal tract - the oesophagus, stomach or small bowel. You can also develop narrowing in the large bowel (colon).

You will need a Gastroscopy or Colonoscopy examination (the appropriate information is attached), depending on where the stricture is so that the endoscopist can see the area of narrowing and dilate the area if needed.

What is a dilatation?

A dilatation balloon is passed through the inside of the endoscope already in position at the stricture site. The endoscopist then sees the dilatation balloon pass through the narrowed area. Some strictures that are torturous will also require the use of X-ray to guide the balloon.

When in the correct position the balloon is inflated so that the narrowing is stretched, and the lumen/outlet widened.

If a balloon dilator is not used, then a guide wire may be passed through the endoscope into the narrowed area. The endoscope is then withdrawn. The endoscopist will then pass a dilator (another type of tube) over the guide wire and down to the area of narrowing. Firm but gentle pressure is used to push the dilator through the stricture/narrowed opening.
 
The procedure may be repeated with larger dilators until the narrowed area has been dilated adequately.

The procedure will usually take between 5 and 15 minutes but sometimes may take longer. Sometimes it is helpful to take a biopsy - a sample of the lining of the gut. A small instrument, called forceps, passes through the endoscope to ‘pinch’ out a tiny bit of the lining (about the size of a pinhead). This sample is sent to the laboratory for analysis.

Getting ready for the procedure

You MUST be nil by mouth of food and liquids for a minimum of 6 hours.

Wear loose fitting washable clothing and leave valuables at home.

On arrival at the department, we will explain the procedure to you and ask you to sign a consent form. You can change your mind about having the procedure at any time.

Before the procedure we will usually give you a sedative (by injection into a vein) to make you feel relaxed and sleepy.

The sedative will not put you to sleep (this is not a general anaesthetic). In addition, we may also give you some pain relief.

The sedative will continue to have a mild effect for up to 24 hours.

If you are an outpatient (not staying in hospital), you must arrange for a responsible adult to come to the unit to collect you and take you home. You will not be able to drive yourself.

What happens during the procedure?

A small amount of oxygen will be given to you, and a plastic ‘peg’ will be placed on your finger to monitor your pulse and oxygen levels. For your comfort and reassurance, a trained nurse will stay with you throughout.

You may feel the balloon as it is put into place; most people find this not too uncomfortable. During the procedure, the endoscopist will put some air into the gastrointestinal tract or large bowel (colon) so that we have a clear view, this will be removed at the end. Balloon will be inserted under direct vision, there may be a need for repeat dilatation procedures. If you make it clear that you are too uncomfortable the procedure will be stopped.

Potential risks

Having a dilatation can result in complications such as perforation (with the stretching resulting in a split of the wall of the area being dilated) but these complications are rare 1% (1 in 100) dilatations. Achalasia patients have a slightly higher risk of 2% (2 in 100).

In the case of lower GI dilatation associated risk of perforation is about 4-5%. Furthermore, there is a small risk of bleeding following GI dilatation.

This complication is evident within a few hours when it occurs. For such patients it means a longer stay in hospital, and possibly an operation.

There is also a very rare complication of having an adverse reaction to the intravenous sedative drugs.

After the procedure

Following the procedure, we will take you to a recovery area while the sedation wears off. We will always do our best to respect your privacy and dignity, for example with the use of curtains. If you have any concerns, please speak to the department sister or charge nurse. Some patients experience chest discomfort post procedure and taking simple analgesia will help with this.

Approximately one hour after the sedation, you will be able to get up (get dressed if you have had a procedure involving your bowel) and be given a drink. One hour after the procedure you will be able to go home. For oesophageal dilatations the endoscopist will usually make a recommendation the consistency of the diet post procedure.

Some people who have this procedure need to be admitted to hospital. If, however you go home on the same day you are advised not to drive, operate machinery, return to work, drink alcohol or sign any legally binding documents for the next 24 hours. We also advise you to have a responsible adult stay with you for the next 12 hours if you have had sedation.

When will I know the result?

Some results will be given to you on the day of the procedure.

Final results from biopsies will be given to you by the healthcare professional who requested the procedure either at a clinic appointment or by letter. A copy of your report may be offered to you, if appropriate. These results can take several weeks to come through. You should discuss details of these results and any further treatment with that person.

Alternatives

As a therapeutic intervention, the only alternatives to oesophageal dilatation may be an oesophageal stent, concerns regarding possible alternatives should be discussed with the doctor who recommended this treatment.

For more information please contact:

The Endoscopy Unit at Salford Royal Hospital on 0161 206 4720 or 0161 206 5959.