Dilation

The esophagus carries food from the mouth to the stomach. At the bottom of the esophagus is a band of muscles that opens and shuts when your child swallows. This allows food into the stomach and also prevents the stomach's contents from rising into the esophagus during digestion. Certain problems, such as esophageal strictures and achalasia, can affect the upper gastrointestinal tract, making it difficult for children to swallow. Dilation (sometimes incorrectly called dilatation) is a procedure that stretches abnormal tissues in and around the esophagus to help children with esophageal problems swallow normally.

At Boston Children's Hospital, dilation is performed by the experienced gastroenterologists in our Gastroenterology Procedure Unit (GPU) and in our main operating room. Our specialists are very highly experienced in this procedure, performing over 600 dilations a year.

What happens during dilation?

First, your child will be administered anesthesia by our pediatric anesthesiologists to help them be completely asleep and comfortable.

The doctor will then gently guide an endoscope — a long, thin, flexible tube equipped with LED lights and a tiny video camera that transmits to several monitors in the room — into your child's mouth and down into the upper digestive system.

Then, the doctor will put a tiny balloon through the tube, and guide it into the esophageal stricture. They will then inflate the balloon just enough to stretch out the abnormal tissue, making it easier for your child to swallow. Your child's doctor may also insert some contrast dye through the endoscope and into the esophagus, and use x-ray images to make sure it's not leaking out of the esophagus.

Lastly, the doctor may insert a small tube called a stent or a sponge through the endoscope and into the area of the stricture. The stent or sponge will remain in place to keep the esophagus open as the tissue heals around it. It will be removed in a follow-up procedure later.

What happens after dilation?

After the procedure, your child's chest may be x-rayed in the recovery area, to make sure there's no evidence of a tear that needs to be repaired. Most kids are able to eat and drink an hour or two after the procedure. We recommend they eat very soft foods for the next few days and gradually start adding back other kinds of foods, according to what feels comfortable to your child.

Sometimes we keep younger children overnight to monitor them, but many children can go home the same day. If the x-ray shows a tear, your child's doctor may place a device called an endoscopic vacuum sponge to help fix the leak, or surgery may be required to fix it. Your child's doctor will speak with you as soon as the procedure is over.