• Reference Number: HEY220-2022
• Departments: Endoscopy
• Last Updated: 10 November 2022

Introduction

This leaflet has been produced to give you general information about your procedure.  Most of your questions should have been answered by this leaflet.  It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion.   If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team who has been caring for you.

What is Oesophageal Dilatation?

It is a procedure to widen the narrowing in your oesophagus. The first step is an endoscopy which you probably have experienced at an earlier date, but the procedure will take a few minutes longer as it is a little more than an inspection. In most cases you will be given a sedative.

The doctor will pass a slim flexible tube with a light on into your gullet (oesophagus) until it reaches the narrowing. In some patients a balloon dilator is used which is inserted into your gullet to the point of the narrowing and is then gently inflated to stretch your gullet. In other patients, a fine wire is passed through the endoscope into your stomach through the narrowing. The endoscope will then be removed leaving the wire in your gullet. The doctor will then pass the dilator over the wire and down to the narrowing. Firm but gentle pressure is used to push the dilator through the narrowing; this procedure is repeated using larger dilators until the narrowed area has been adequately stretched.  Occasionally an X-ray may be required during the procedure. The procedure will take about 10 minutes.

Why do I need Oesphageal Dilatation?

You have probably been troubled by some symptoms which have led to your doctor advising you to have treatment called an oesophageal dilatation to stretch the narrowing (stricture) in your gullet (oesophagus).

This will help relieve the swallowing difficulties you are experiencing. This procedure may have to be repeated periodically to enable food and fluids to pass through the gullet (oesophagus).

Can there be any complications or risks?

Perforation of the gullet

Oesophageal dilatation carries a risk of perforation (hole) of the gullet. In most circumstances the risk is 1%, but there are reports of the risk reaching 10%. If this occurs, you may feel a pain in your chest or back, be short of breath and feel generally clammy and unwell.
If you have any of these symptoms YOU MUST CONTACT your doctor or the hospital Endoscopy Department or Ward 100 HRI (out of hours) as soon as possible.

Sedation

Some people, for reasons we still do not fully understand, are particularly sensitive to the sedative drug. The breathing can be too shallow and too slow. In these cases we stop the examination, give more oxygen and if required we can give an antidote to reverse the effect of the sedation. This is usually all that is needed and the person recovers with no ill or lasting effects.

In some cases, when people have another serious illness e.g., heart disease, stroke, unstable angina, severe asthma or chronic bronchitis, the sedation drug can cause difficulty in breathing. This is rare and is why we monitor breathing and heartbeat throughout; and why we give oxygen by nasal tubes.

Common problems, which are not serious, include a haematoma (big bruise from your sedation needle) a sore throat and bloating.

What if I refuse to have the Oesophageal Dilatation?

This will not alter the manner in which we treat you and your standard of care will not change. However, it will be an important piece of information about your gastrointestinal tract that we will not have and you will not get the relief of your swallowing problem. Please discuss this with your doctor/specialist team.

Who will do the procedure?

It will be a consultant or senior doctor who is trained and experienced in performing the procedure, sometimes called an endoscopist.

Where will the test be performed?

Oesophageal dilatation is mostly performed in the Endoscopy Department. Specially trained doctors and nurses work here and are very experienced in performing oesophageal dilatation and in the care it involves.

It will be done at Hull Royal Infirmary or Castle Hill Hospital depending on where your consultant is based. Please make sure you go to the correct Endoscopy Department. Directions will be given with your appointment letter. All the staff will help to make your stay as easy and dignified as possible. Please do not be afraid to ask questions.

How do I prepare for the procedure?

Please read the information leaflet. Share the information with your partner and family (if you wish) so that they can be of help and support. There may be information they need to know, especially if they are taking care of you following this examination. Complete the health questionnaire sent/given to you as fully as possible.

To allow for a clear view, your stomach and first part of your intestine needs to be empty.

You should not have any thing to eat and drink for at least 6 hours before your test. Do take any regular medicines up to this point.

If you have diabetes (especially taking insulin) or you have serious heart, lung or kidney problems, or concerned that a health problem you have may be affected, then contact the endoscopy department at the hospital you are having your examination (see contact numbers).

• Warfarin – These are blood thinning tablets and usually have to be stopped for a period of time before your test, please contact your endoscopy department for advice.
• Latex – Please inform the department if you have a confirmed latex allergy as this will affect your appointment time.
• Creutzfeldt-Jakob disease/variant Creutzfeldt-Jakob disease (CJD) commonly known as mad cow disease – Please inform the department if you have been notified that you are at risk of CJD/vCJD for public health reasons.
• Clopidogrel (Plavix) – Please inform the department if you are taking these tablets as these may need to be stopped prior to your procedure.
• Pregnancy – It is important that you inform us if there is a possibility that you may be pregnant. Any information you share with us will be kept strictly confidential.

If you take any of the following blood thinning tablets please contact the Endoscopy Department before your appointment for further advice:

• Apixaban
• Rivaroxaban
• Dabigatran
• Dabigatran
• Argatroban
• Edoxaban

What happens to me in the Endoscopy Department?

Our friendly reception staff will greet you on arrival. They will let a nurse know that you have arrived. Occasionally there may be a delay in your appointment time due to any emergency taking place. If there are any delays you will be notified as soon as possible and be kept informed.
A nurse will collect you from the waiting room and explain what will happen next. You will be given an approximate time of when you may be collected to go home. It is advisable to leave any valuables at home.

We will ask you questions about your general health and work through the health questionnaire you have completed for us. Please feel free to ask questions.

The endoscopist will meet you and explain the test to you. You will both sign a consent form. This is to show you understand what will happen and agree to the procedure being performed. At any point during the procedure you can withdraw your consent and ask for the procedure to stop. If this happens the endoscopist will stop the test and take the scope out. If you have any queries or worries, please tell us.

We will check your blood pressure, pulse, oxygen levels and weight, before your test.

If you wear glasses or dentures, you will be asked to remove them. You will be taken to the examination room and made comfortable on a bed on your left-hand side. To keep your mouth open, a plastic mouth guard will be placed between your teeth. A fine plastic tube will rest by your nostrils to give you some extra oxygen. A probe will be placed on your finger to monitor your oxygen levels and pulse rate.

Do I need sedation?

Yes. People have sedation to keep them comfortable while the doctor carries out the procedure. Sedation is given through a flexible needle in the back of your hand or arm. It makes you feel sleepy and relaxed but does not put you to sleep. You can still respond to what is happening.

Do I really need someone with me after sedation?

Yes, this is very important. The sedation given can have effects, which can last up to 24 hours after the test. You can become forgetful and also sleepy again.

Your test may be cancelled if you do not arrange to have someone to collect you and stay with you for the next 24 hours.
We strongly recommend that for the next 24 hours you:

• Do not drive
• Do not return to work or operate machinery
• Do not sign any important/or legal documents
• Are not left alone, you may be at risk of injuring yourself
• Are not left alone to care for children

If you are an outpatient, the person accompanying you will be contacted to collect you. If you are an inpatient you will be transferred back to your ward.

What happens when the test is finished?

You will need to rest on a trolley in the recovery room. We will check your blood pressure, pulse and temperature on a regular basis. You will need to stay in the department longer after this procedure so we can monitor you closely, you will then be helped to a chair and given a drink. Your relative or friend will then be contacted to collect you. It is quite likely that the back of your throat will feel sore for the rest of the day.

You may feel bloated if some air remains in your stomach. Both discomforts usually pass without any medication. Your swallowing may not appear to be improved or may seem worse for 1-2 days owing to the swelling of the tissues. You may find you have some streaks of blood in your saliva after the procedure this is quite normal and should stop without any further treatment.

When do I get the results?

The Recovery nurse will explain your results to you and (if you wish) the results will be told to your carer. They will be written on your discharge form with any instructions that you need to follow. If you wish, the nurse will repeat the result to you before you leave the department. Your own doctor or hospital doctor will receive a copy of the results.

Will I ever need an Oesophageal Dilatation again?

Yes, it is possible this procedure may have to be repeated periodically to enable food to pass down your gullet to your stomach.

If you have any further swallowing problems you can contact your Endoscopy Department directly for advice.

Further information

If you require further information about your test your GP, your Consultant, and the Endoscopy Department is a valuable source of information. Further information about your rights with regards to consent can be found in the following documents:

• Department of Health (2001), Guide to Consent for Examination or Treatment.
• Department of Health (2001), Consent – What you have a right to expect.
• A Guide for Adults. (Available from the Endoscopy Department)
• A Guide for Relatives and Carers. (Available from the Endoscopy Department)

These are free of charge.
Visit the Department of Health’s website at: www.doh.gov.uk and, for consent: www.doh.gov.uk/consent
Useful contact numbers:
The Endoscopy Department, Castle Hill Hospital Tel: (01482) 622069 Mon – Fri: 8am – 5pm
The Endoscopy Department, Hull Royal Infirmary Tel: (01482) 674790 Mon – Fri: 8am – 5pm
Ward 100 Hull Royal Infirmary Out of hours (01482) 675100

What do the words in the leaflet mean?

Biopsy – A sample of tissue is taken for analysis.
Consent – This is the agreement between you and the endoscopist. You are agreeing to have investigations or treatment and that you understand the purpose, benefits, alternatives and risks. You and the endoscopist during this process usually sign a consent form.
Endoscopy – Inspection of your stomach with a flexible camera.
Endoscopy Department – The place where your procedure takes place.
Endoscope – A tube for looking inside the body.

Endoscopist – This can either be your consultant, an experienced and trained doctor or an experienced and specially trained practitioner.
Oesophageal Dilatation – Stretching of the gullet to alleviate problems of swallowing.

This leaflet has been written with the help, support, advice and collaboration of:

• Consultants of the Department of Gastroenterology
• Consultants of the Surgical Department
• Staff of the Endoscopy Department
• Patients attending the Endoscopy Department

Endoscopy Department contact numbers:

Hull Royal Infirmary –  Tel: 01482 674790 (direct line)

Castle Hill Hospital  –  Tel: 01482 622069 (direct line)

You will be given an Oesophageal Dilatation Information Checklist to complete as part of the consent for your procedure – please see the link

HEY220-2022_Oesophageal_Dilatation Consent form word.doc

 

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.