Balloon / Bougie dilatation of strictures

What is a stricture?

A stricture is where the oesophagus (otherwise known as the gullet or 'foodpipe' ie the tube connecting the mouth and the stomach) narrows and causes problems swallowing food (the medical term for this is 'dysphagia') or even swallowing liquids if the condition worsens.

Oesophageal strictures can be caused by many things, but the main cause is GERD. Where a patient has suffered GERD for a long period, acid from the stomach backing up into the oesophagus can damage the lining and cause the oesophagus to narrow. Other causes of strictures include...

  • Swallowing a chemical or object that damages the oesophagus, eg household cleaning liquids (which often are made of lye) and button type watch batteries
  • Prior surgery of the oesophagus
  • Cancer and/or radiation therapy
  • Enlarged veins in the oesophagus
  • Allergic reactions (medical term - eosinophilic oesophagitis) that mainly affects children and young adults
  • Some rare skin diseases

How is a stricture diagnosed?

There are two main methods of diagnosing stricture...

1) Barium meal

A barium meal involves swallowing a small 'meal' containing barium which shows up on an x-ray so the doctor can see if the meal gets stuck or if it slows in its journey to the stomach

2) Endoscopy

An endoscope, which is a narrow tube with a light and camera at the end of it, is lowered through the mouth into the oesophagus

How is a stricture treated?

The standard treatment is dilatation (sometimes also referred to as 'dilation') where the narrowed section of the oesophagus is widened. This can be done using one of two different techniques...

Balloon dilatation

Also referred to as 'pneumatic dilatation'), this involves the insertion of a balloon type device into the affected section of the oesophagus and then inflated to expand the oesophagus. The balloon is inserted through an endoscope

Bougie dilatation
A bougie is a thin semiflexible cylindrical instrument (the word 'bougie' means 'candle' in French) used to widen the oesophagus. Generally a sequence of bougies are inserted, starting with a thin one and building up to thicker bougies to widen the narrowed section.

In some cases more than one procedure may be required to fully widen the stricture.

Once the stricture has been widened using one of these two techniques, you may need to take a medicine known as a 'proton pump inhibitor' which inhibits the stomach's production of acid and allows the affected section of the esophagus to heal.

Can strictures in other areas of the bowel be dilated and treated endoscopically?

Strictures can also be found in other areas of the bowel, including the stomach, small bowel and colon.  These strictures can also be dilated using the balloon dilator, inserted through the gastroscope or the colonoscope.