Gastroenterology:   Photographs

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Stretching an Esophageal Stricture

Narrow Esophageal Stricture
This is a photo taken at the bottom of the esophagus of a 44 year old bricklayer. He came to our office complaining that he had difficulty swallowing his food. He had heartburn for over 11 years. In the past 3 years, his food has been sticking on the way down. To compensate, he has gradually switched to softer foods, avoiding dry bread, meats, apples, etc. Little by little, he had gone from a normal adult diet to one of mostly baby food, milkshakes, and beer. More solid food would not pass and he would have to vomit it back up. After one embarrassing episode at a local restaurant, his wife insisted he see a doctor. His family doctor referred him to our center for a gastroscopy examination. During the exam, Dr. Fusco found this narrow spot in the lower esophagus. Fortunately, there was no cancer, no Barrett's (precancer) and no ulcer. Just a ring of scar tissue caused by chronic heartburn. This "stricture" was blocking the passageway.

Placing Balloon Dilator
Since there was no cancer and no active ulcer, Dr. Fusco decided to dilate, or stretch, this narrow esophageal stricture. This is done by a technique very similar to an angioplasty of the heart where a small balloon catheter is used to open up a blocked coronary artery.

In this case, however, a deflated "cigar-shaped" balloon dilator is passed down through the narrow hollow instrument channel within the gastroscope. The deflated balloon comes out the other end inside the lower esophagus, just above the narrow stricture. The doctor is able to monitor the passage of the balloon on the video monitor. In this photo, you can see the deflated balloon being passed into the narrow spot.
Inflated Balloon Dilator
Once the balloon dilator is in position "stradling" the stricture, the balloon is inflated with water. As the water inflates the balloon, it becomes large and pushes back the walls in the narrow spot. Here you can see the inflated balloon inside the stricture. The amount of dilation is carefully monitored by using a pressure gauge. After several minutes, the balloon is deflated and the dilator removed.
After Balloon Dilation
This photo was taken after the balloon was deflated. You can see how nice and open the narrow spot is now. Of course, there is a small amount of bleeding. This is normal after an esophageal balloon dilation. A little blood is a good sign - meaning that the dilation was successful. Most patients are dischared within one hour of the procedure and may return home with assistance. We ask patients to stick to a soft diet for several days and always chew their food well. We also recommend that patients take prescription drugs to prevent acid from backsplashing up through the newly opened segment. Before we had effective medications for acid reflux, patient with benign esophgegeal stricture often had to be redilated once or twice per year. Now that we have powerful drugs (like Prilosec, Prevacid, Aciphex, and Protonix) to prevent acid backsplash, most patients find that one session of balloon dilation may last several years. If you have trouble swallowing, see your doctor immediately for further evaluation. After this session of balloon dilation and with a daily dose of Prilosec, this patient has had no heartburn and no difficulty swallowing. He was referred back to his family doctor for followup and asked to return to Three Rivers Endoscopy Center in 3 years for a checkup.


Text & Images Courtesy of Three Rivers Endoscopy Center
© Dr. Robert Fusco, Three Rivers Endoscopy Center, All Rights Reserved

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