Esophageal Dilation – EGD Procedure With Dilation of the Esophagus
For me, an EGD with dilation of my esophagus has, for years, been something I look forward to. Don’t get me wrong, it’s not fun, but to me it means “relief is on the way”. Since I was 22 (when I had my first one, 30 years ago), dilating the esophagus always worked to a certain extent. My esophagus would be so small and tight that I could not eat real food (hence, time to get an EGD!). Then, after recovery from the EGD, I could swallow better. For many years it helped enough to where I would go back to eating normally, even eating out at restaurants and fast food!
It’s a bandaid to the real underlying problem with EoE, but for many it’s the only thing that helps. People like me are allergic to so many foods that it’s very difficult to find relief by restricting certain foods. You don’t know which foods are the culprit! SO, the EGD procedure is what keeps us going.
Here’s what happens when you go in for yours:
- Once you get checked into the hospital they put you in the “prep room” where they get you ready. You’ll talk to a nurse asking questions about your health, etc. You’ll also talk to an anesthesiologist telling you what they will be doing to put you under during the procedure.
- In the prep room they’ll have you get dressed in that gorgeous gown that barely covers you, and you’ll notice how COLD it is in the hospital (they like the temp cold in most of them!). Then they put the i-v in you and start liquids in it.
- When you’re ready, they’ll roll you into the procedure room and you’ll likely get to talk to the doctor for a couple of minutes before they put you under. He or she will tell you what’s going to happen, and you can ask questions if you want.
- They will either have you lay on your side or flat on your back (doctor’s choice) and insert a mouth guide into your mouth (like a mouthpiece) that they push the guide wire and tubes down.
- When the talking is over, and they’re ready to begin, the anesthesiologist will tell you they’re going to start giving you meds. They might ask you to count to 10, and usually if you get past 3 or 4 you probably won’t remember.
- They like to use propofol to knock you out nowadays (the stuff Michael Jackson OD’d on). That’s because you wake up much faster and more alert with that medicine, where the ones they used to use you’d be groggy and take longer to “wake up” and leave the hospital. I’ve also noticed that with propofol you’re alert and awake and remember more once you wake up. My wife used to laugh all the way home because I would ask the same questions over and over again. Doesn’t happen anymore with Propofol.
- Once you’re unconscious, the doctor will start with a scope to take a look at your esophagus. If you’re EoE is really bad, he/she won’t be able to fit the scope down. So they’ll either get the neonatal scope and try that, or they’ll grab a savory dilator and stretch you first. Then they should be able to get the scope down to take a look.
- Depending on what things look like, the doctor will then do his or her best to get you the “most bang for your buck”. If you were too small for the scope, they will probably use 2 or 3 dilators and stretch you up to a 9, 12 or 13mm, or maybe even more if your esophagus responds well.
- The risk of the procedure (although very small, less than 1%) is perforation of the esophagus. This is where there is a tear in the lining of your esophagus and food or water can actually escape into your body through that perforation. This is bad, but it’s rare. A lot has to do with your doctor and their judgment call on how much they want to stretch you. Experienced doctors know what they’re doing and you should feel safe.
- My old doctor was scared to death of me. Every time he stretched me he worried about tearing (this is before they knew what EoE was). Back then they thought the risk of perforation was 10%. They’ve since downgraded that risk a LOT since it’s so much less now they they have so much experience doing these. My new doctor is much more aggressive, because he knows the risk is so low. My old doctor never dared to stretch me past 13mm. My new one has gone to 15mm multiple times.
- What happens when they stretch you is not pretty. My doctor says he doesn’t even look with the scope after the last stretching anymore because it’s so horrid looking and it was giving him nightmares. It looks like they tore you up, which they sort of did! My doctor says it looks like they turned you into hamburger in there. Again, this is normal because they are forcefully stretching your esophagus.
- Once the doc is done stretching you, you go to recovery and wake up in a short time. Then they’ll talk to you and see how you feel, and maybe get you some water. They’ll tell you that you’ll have a lot of gas (since they pushed so much air into you for the procedure). They’ll give you some instructions and a “what to do” sheet for any potential trouble when you get home. But pretty much, you wake up and slowly get strength enough to get dressed and get in the wheelchair to be wheeled to your car (or you might walk).
- When you get home, go to bed and sleep. Rest and let your body heal and recover. You can drink water, and technically you could eat something soft, but you probably won’t want to. You’ll just want to sleep it off.
- For me, a few hours (3, 4 or 5) and I’m starting to wake and maybe feel like drinking something other than water. I’ll take Tylenol because it hurts for the next 24 hours or more (they did turn your esophagus into hamburger!). Sometimes I’m up and around that day (after 6 or 7 hours or so) and can function, although it still hurts to swallow. Sometimes I just rest until the next day. Either way, it’s going to be sore in the throat for a couple or few days, especially when you swallow food. Stay with soft foods until the pain subsides enough.
- Once the pain goes away, and you get back into normal schedule and eating, you’ll notice that it’s much easier to swallow than before (hopefully!). Don’t get me wrong, unless they stretched you to 20mm (very unlikely) you won’t be eating and swallowing like everyone else around you. You still have EoE! It’s just better than it was before to swallow.
- The bad news? Well the doctor will tell you that it could be “months” before swallowing returns to not-so-great. My experience for most of my life was that I swallowed much better for a year or two before I noticed the benefit was mostly gone. Not so much lately, as I’ve only felt better swallowing for weeks, maybe a month. Most will have better experience with it than that.
The result of your esophageal dilation and how long you will be able to swallow better depends completely on your underlying EoE condition. Meaning, the extent you’re eating food that you’re allergic to, and how much your body is producing eosinophils to fight those allergens will determine your longevity of improvement.
EGD’s are NOT the final answer. They are used to help you make it UNTIL you find the final answer, which is what’s causing the eosinophils in the first place.
Final Thoughts: You may hear scary things from people talking about having this procedure done. Trust your doctor and talk about any risks and your condition with them. My experience has been nothing but positive for having as many EGD’s done as I have. If it weren’t for this procedure, I would’ve been dead many years ago.
Your procedure and recovery could be very mild if they don’t stretch you very far, but if they do stretch you a lot, be prepared for a painful-swallowing few days afterward. Don’t be concerned with the pain, it’s normal to have this pain after a good stretch. Just watch out for abnormalities like bleeding or pain that’s more than expected.