KidsMD Health Topics

Dilatation

  • Dilatation is a procedure that helps children with problems affecting the upper digestive system, such as swallowing. It’s faster and less expensive than a traditional operation.

    click to enlarge

    At the bottom of the esophagus—the tube that carries food from the mouth to the stomach—is a band of muscles that opens and shuts when you swallow. This does two things:

    1. It allows food into the stomach.
    2. It keeps the stomach's contents from rising into the esophagus during digestion.

    Sometimes these muscles grow weak, and don’t open the right way when you swallow (achalasia). This might result in pain, difficulty swallowing or food getting stuck in the esophagus.

    During dilatation, a doctor opens the band of muscles at the bottom of the esophagus with a small balloon. This allows a patient with achalasia to again swallow normally.

    When do doctors order dilatations?

    Doctors may order dilatations for children with strictures (narrowing of the esophagus). Strictures might be:

    About 98 percent of dilatations are esophageal. They could also be performed on the pylorus muscle in the stomach, and the colon.

    Dilatation at Children’s Hospital Boston

    Here at Children’s, dilatation is performed by the experienced clinicians of our Gastroenterology Procedure Unit (GPU)—a full-service unit providing an array of diagnostic and therapeutic endoscopy procedures in a safe, comfortable environment.

    Lots of gastroenterology (GI) doctors can perform dilatations, but pediatric expertise is crucial. Our specialists are very highly experienced, performing close to 100 per year.

    Our team includes 19 attending physicians, 12 nurses and 6 endoscopy technicians who support the day-to-day practice of the unit. We also assist in the care of children with life-threatening cases in other areas of the hospital, such as the intensive care and surgical units, using our portable equipment. All nurses and physicians are certified in pediatric advanced life support (PALS).

    ELLIOT'S JOURNEY
    Elliott Cleckler was born with long-gap esophageal atresia— a serious condition that is notoriously difficult to treat. In this short video series, his parents, Jay and Heather, share their story.


    Dilatation: Reviewed by Michael Manfredi, MD

    © Children’s Hospital Boston, 2011


    Contact Us
    Children's Hospital Boston
    300 Longwood Avenue
    Boston MA 02115 

    617-355-6172

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  • We understand that you may have a lot of questions when your child is scheduled for a dilatation: 
    • Does it hurt?
    • What are the risks?
    • What do I need to do?

    We’ve provided some answers to those questions here, and our experts can explain the procedure in more detail. 

    Does dilatation hurt?

    Since the gastrointestinal tract doesn’t have pain sensors, your child will not feel any pain; and our staff will be paying very close attention to make sure that she is sleeping comfortably.

    What should I do to prepare my child for dilatation?

    Your child must have an empty stomach for dilatation.  Here are some guidelines to follow:

    After midnight the night before your child’s procedure, do not give him any:

    • solid food
    • milk
    • milk products
    • formula
    • juices with pulp, such as orange juice, pineapple juice or grapefruit juice

    Your child can have clear liquids (including water, breast milk, apple juice, cranberry juice, Pedialyte® and Gastorade®) up until the times below:

    • if younger than six months - two hours before the test time
    • if older than six months – three hours before test time

    Who will perform the dilatation? 

    A gastroenterologist (GI)— doctor who specializes in the gastrointestinal system—will perform the procedure. There will also be a nurse present, who will carefully observe your child for the entire time. Our GI specialists perform close to 100 dilatations each year.  

    Where will my child’s dilatation be performed?

    At Children’s Hospital Boston, dilatations are most often performed in ourGastroenterology Procedure Unit (GPU).  Depending on scheduling, sometimes they may also be performed in the operating room. Your child’s doctor will determine the best location, and if your child is scheduled for the operating room, a nurse will call you the day before to tell you where to come. 

    Where will I be during the test?

    We ask that you wait for your child either in the GPU Family Waiting Area, or elsewhere in the hospital.

    What will happen during the procedure?

    First, your child will be given medicine intravenously (through an IV) to help her get very sleepy and relaxed or fall asleep. The doctor may spray a numbing medicine in her mouth to make the procedure more comfortable.

    She’ll be attached to a heart monitor by wires connected to three stickers on her chest, and also have a small lighted sticker on one of her fingers or toes that is connected to an oxygen monitor. 

    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 her upper digestive system.

    Then, the doctor will put a tiny balloon through the tube, and guide it into the stricture. He or she will then inflate the balloon just enough to stretch out the muscles, making it easier for her to swallow.

    After this, your child’s doctor may 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 through the endoscope and into the area of the stricture. The stent 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 the procedure?

    After the procedure, your child’s chest will 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 for older children, if the x-ray looks normal and he’s able to drink, it’s usually okay to go home. If the x-ray shows a tear, surgery may be required to fix it.

    How will we be informed of the results?

    Your child’s doctor will speak with you as soon as the procedure is over.

    If you have any questions about the procedure, call the GI/Endoscopy Unit at 617- 355-6172 between 8 a.m. and 4 p.m. Ask to speak to one of the nurses.

    For emergencies, you can call a GI doctor 24 hours a day. Call the hospital page operator at 617-355-6369 and ask for the GI fellow on call.

    SUPPORT SERVICES
    Learn about general information and resources for Children’s patients and their families.



    In-Depth

    We understand that you may have a lot of questions when your child is scheduled for a dilatation: 

    • Does it hurt?
    • What are the risks?
    • What do I need to do?

    We’ve provided some answers to those questions here, and our experts can explain the procedure in more detail. 

    Does dilatation hurt?

    Since the gastrointestinal tract doesn’t have pain sensors, your child will not feel any pain; and our staff will be paying very close attention to make sure that she is sleeping comfortably.

    What should I do to prepare my child for dilatation?

    Your child must have an empty stomach for dilatation.  Here are some guidelines to follow:

    After midnight the night before your child’s procedure, do not give him any:

    • solid food
    • milk
    • milk products
    • formula
    • juices with pulp, such as orange juice, pineapple juice or grapefruit juice

    Your child can have clear liquids (including water, breast milk, apple juice, cranberry juice, Pedialyte® and Gastorade®) up until the times below:

    • if younger than six months - two hours before the test time
    • if older than six months – three hours before test time

    Who will perform the dilatation? 

    A gastroenterologist (GI)— doctor who specializes in the gastrointestinal system—will perform the procedure. There will also be a nurse present, who will carefully observe your child for the entire time. Our GI specialists perform close to 100 dilatations each year.  

    Where will my child’s dilatation be performed?

    At Children’s Hospital Boston, dilatations are most often performed in our Gastroenterology Procedure Unit (GPU).  Depending on scheduling, sometimes they may also be performed in the operating room. Your child’s doctor will determine the best location, and if your child is scheduled for the operating room, a nurse will call you the day before to tell you where to come. 

    Where will I be during the test?

    We ask that you wait for your child either in the GPU Family Waiting Area, or elsewhere in the hospital.

    What will happen during the procedure?

    First, your child will be given medicine intravenously (through an IV) to help her get very sleepy and relaxed or fall asleep. The doctor may spray a numbing medicine in her mouth to make the procedure more comfortable.

    She’ll be attached to a heart monitor by wires connected to three stickers on her chest, and also have a small lighted sticker on one of her fingers or toes that is connected to an oxygen monitor. 

    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 her upper digestive system.

    Then, the doctor will put a tiny balloon through the tube, and guide it into the stricture. He or she will then inflate the balloon just enough to stretch out the muscles, making it easier for her to swallow.

    After this, your child’s doctor may 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 through the endoscope and into the area of the stricture. The stent 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 the procedure?

    After the procedure, your child’s chest will 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 for older children, if the x-ray looks normal and he’s able to drink, it’s usually okay to go home. If the x-ray shows a tear, surgery may be required to fix it.

    How will we be informed of the results?

    Your child’s doctor will speak with you as soon as the procedure is over.

    If you have any questions about the procedure, call the GI/Endoscopy Unit at 617- 355-6172 between 8 a.m. and 4 p.m. Ask to speak to one of the nurses.

    For emergencies, you can call a GI doctor 24 hours a day. Call the hospital page operator at 617-355-6369 and ask for the GI fellow on call.

  • Here at Children’s Hospital Boston, our care is informed by our research. Children’s is home to the world’s most extensive research enterprise at a pediatric hospital.

    We’re known for our science-driven approach. In fact, we’re home to the world's most extensive pediatric hospital research enterprise, and we partner with elite health care and biotech organizations around the globe. But as specialists in innovative, family-centered care, our physicians never forget that your child is precious, and not just a patient.

    Our Gastroenterology Procedure Unit performs cutting-edge research studies in a number of areas, including:

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