When it comes to gastrointestinal health, early detection and treatment of narrowing in the digestive tract—also known as strictures—can significantly improve a patient’s quality of life.

Strictures can lead to uncomfortable and even dangerous symptoms such as difficulty swallowing, abdominal pain, or bowel obstruction. One of the most effective treatment methods for these conditions is dilatation—a minimally invasive procedure designed to widen narrowed areas of the gastrointestinal (GI) tract.

This guide will walk you through everything you need to know about the dilatation of strictures, from the causes and symptoms to the treatment process and recovery expectations.

Whether you’re a patient preparing for the procedure or simply seeking to better understand your treatment options, this article will provide a clear and compassionate overview of this important GI therapy.

What Are Strictures?

Strictures refer to abnormal narrowing in the gastrointestinal tract. This narrowing can occur anywhere along the digestive system, including the esophagus, stomach, small intestine, or colon.

Strictures can be caused by various conditions, including:

• Gastroesophageal reflux disease (GERD)
• Inflammatory bowel diseases (IBD) like Crohn’s disease or ulcerative colitis
• Radiation therapy
• Surgical scarring
• Peptic ulcers
• Infections
• Cancer or tumors
• Prolonged use of nasogastric tubes or caustic injury

When the GI tract narrows, it restricts the movement of food, liquids, and digestive materials, often leading to symptoms that vary based on the stricture’s location.

Common Symptoms of GI Strictures

The symptoms of strictures largely depend on where they occur in the digestive system. Common signs include:

• Esophageal Strictures: Difficulty swallowing (dysphagia), food getting stuck, chest pain, and regurgitation.
• Gastric Strictures: Nausea, vomiting, bloating, early satiety, and weight loss.
• Small Bowel Strictures: Abdominal pain, cramping, nausea, vomiting, and signs of obstruction.
• Colonic Strictures: Changes in bowel habits, bloating, and abdominal discomfort.

If left untreated, strictures can lead to serious complications such as malnutrition, intestinal blockage, or perforation.

What Is Dilatation of Strictures?

Dilatation of strictures is a therapeutic procedure used to stretch or widen a narrowed segment of the GI tract.

This allows for the smoother passage of food and digestive contents, alleviating symptoms and improving the patient’s quality of life.

There are two main types of dilatations:

• Endoscopic Balloon Dilatation: A deflated balloon is inserted into the stricture site via an endoscope and then gently inflated to widen the narrowed area.
• Bougie Dilatation: A series of flexible, tapered tubes (called bougies) are inserted through the stricture, progressively increasing in size to expand the passage.

Both methods are typically performed under sedation or anesthesia and may be done as an outpatient procedure, depending on the patient’s condition.

Preparing for the Procedure

Before undergoing a dilatation, your gastroenterologist will perform a detailed assessment, which may include:

• Endoscopy: To visually inspect the stricture.
• Imaging Tests: Such as barium swallow, CT scan, or MRI to evaluate the severity and location.
• Biopsy: If cancer or inflammation is suspected.

   

Preparation instructions typically include:

• Fasting: No food or drink for at least 6–8 hours before the procedure.
• Medication Adjustments: Stopping certain medications like blood thinners or antiplatelet drugs.
• Medical History Review: Including allergies, previous surgeries, or anesthesia reactions.

What to Expect During the Procedure

1. Arrival and Sedation

Upon arrival, a nurse will check your vital signs, review your medical history, and start an IV line for medications. You’ll receive sedation to help you relax and minimize discomfort.

2. Endoscope Insertion

Your doctor will insert an endoscope (a thin, flexible tube with a camera) through your mouth or anus, depending on the location of the stricture.

3. Dilatation

Once the narrowed segment is located, the physician will use either a balloon or bougie to gently expand the area. The dilatation may last a few seconds to a couple of minutes.

4. Monitoring

After the procedure, you’ll be monitored in a recovery area until the sedation wears off. Most patients go home the same day.

Risks and Complications

Dilatation of strictures is generally safe, but like any medical procedure, it carries some risks. Potential complications include:

• Bleeding: Especially if the area is inflamed or ulcerated.
• Perforation (Tear in the GI wall): Though rare, this is the most serious risk and may require surgery.
• Infection
• Recurrence of the stricture
• To reduce these risks, it’s crucial to follow all pre- and post-procedure instructions and inform your healthcare provider of any underlying conditions or medications.

Post-Procedure Care and Recovery

Recovery after dilatation is typically smooth, especially if the procedure was performed without complications.

What to Expect Afterward

• Mild sore throat (if upper GI)
• Bloating or gas
• Slight cramping
• Temporary dietary restrictions

Most patients can resume normal activities within 24 hours, although you may need to stick to soft foods for a short period.

Follow-Up Care

• Repeat Procedures: Some patients may require more than one session to fully resolve the stricture.
• Ongoing Monitoring: Your doctor may recommend follow-up endoscopies, especially if the underlying condition is chronic (like Crohn’s disease).
• Medications: Anti-inflammatory drugs or acid reducers may be prescribed to prevent recurrence.

   

Managing the Underlying Cause

Successful treatment of strictures also means managing the root cause. Depending on your condition, your doctor may recommend:

• For GERD-related strictures: Proton pump inhibitors (PPIs) or surgical interventions.
• For IBD patients: Immunosuppressants or biologic therapies.
• For post-surgical strictures: Regular monitoring and additional dilatations if needed.
• For malignant strictures: Additional interventions like stent placement or surgery.

When to Call Your Doctor

After a dilatation, seek medical attention if you experience:

• Severe chest or abdominal pain
• Vomiting blood or passing black stools
• Fever or chills
• Difficulty swallowing or breathing

These could be signs of complications and should be addressed promptly.

Frequently Asked Questions (FAQs)

Q: Will I need multiple procedures?
A: It depends on the cause and severity of your stricture. Some patients achieve relief after one session, while others may need multiple treatments.

Q: Is dilatation painful?
A: The procedure is usually well-tolerated under sedation. Mild discomfort or a sore throat may occur afterward.

Q: How long does the effect last?
A: Duration varies. In some cases, the stricture can recur, especially if the underlying disease isn’t well-managed.

More About Dr. Deetlefs

Dr. Deetlefs is a highly respected specialist in the field of gastroenterology, known for his compassionate patient care and extensive expertise in a wide range of diagnostic and therapeutic procedures.

With years of clinical experience, he provides expert medical assistance in managing complex gastrointestinal conditions, including endoscopic treatments such as dilatation of strictures, colonoscopy, gastroscopy, and the placement of esophageal, gastric, and duodenal stents.

Dr. Deetlefs is dedicated to ensuring that each patient receives personalized care tailored to their unique needs, backed by the latest advancements in gastrointestinal medicine. His thorough approach, combined with a commitment to patient education, makes him a trusted figure in the journey toward better digestive health.

If you would like to book an appointment with a gastrointestinal (GI) specialist or would simply like more information on a particular GI topic, don’t hesitate to use our online booking form or call Dr. Deetlefs at 021 551 867.

Conclusion

Dilatation of strictures is a safe and effective procedure that provides significant relief from the symptoms caused by narrowed segments in the GI tract. Whether due to GERD, IBD, or post-surgical scarring, strictures can severely impact quality of life if left untreated.

With modern endoscopic techniques and tailored medical care, patients can expect improved function, reduced discomfort, and a path toward long-term digestive health.

If you are experiencing symptoms of a stricture or have been advised to undergo dilatation, speak with your gastroenterologist to fully understand your options. Early treatment and consistent follow-up are the keys to a smoother recovery and better health outcomes. 

 
Introduction

The human digestive system is a complex network of organs, each with a specific role to play in the digestion and absorption of nutrients.

While the stomach, small intestine, and large intestine are well-known players in this process, there’s one organ that often remains unseen and unexplored: the small intestine.

Measuring around 20 feet in length, the small intestine is a crucial part of the digestive system, yet its deep location has made it challenging to examine.

In this guide, we will explore the fascinating world of the small intestine and discuss a remarkable tool for investigating it: double balloon enteroscopy.

Understanding the Small Intestine

The small intestine is where the majority of nutrient absorption takes place.

It is divided into three sections: the duodenum, the jejunum, and the ileum.

Despite its essential role, the small intestine has historically been challenging to examine due to its length, intricate folds, and deep location within the body.

What Is Double Balloon Enteroscopy?

Double balloon enteroscopy (DBE) is a specialized endoscopic procedure that allows healthcare providers, typically gastroenterologists, to access and visualize the small intestine.

It is named for the use of two balloons – one on the endoscope and another on an overtube – which work together to advance and anchor the endoscope through the small intestine.

DBE is performed to diagnose and treat various small intestine conditions, such as Crohn’s disease, small bowel tumors, and unexplained gastrointestinal bleeding.

It is a minimally invasive procedure that offers significant advantages over traditional diagnostic methods, such as surgery.

When Is Double Balloon Enteroscopy Used?

Diagnostic Applications:

1. Obscure Gastrointestinal Bleeding: DBE is especially valuable in diagnosing obscure gastrointestinal bleeding, where the source of bleeding is challenging to identify through other imaging techniques.
2. Suspected Small Bowel Tumors: When small bowel tumors are suspected, DBE can provide a direct view of the lesions and collect tissue samples for biopsy.
3. Evaluation of Crohn’s Disease: DBE is used to assess the extent and severity of Crohn’s disease in the small intestine, aiding in disease management and treatment planning.
4. Unexplained Abdominal Pain: For individuals with chronic unexplained abdominal pain, DBE can help identify sources of discomfort within the small intestine.

Therapeutic Applications:

1. Polyp and Tumor Removal: During DBE, gastroenterologists can remove small polyps and tumors from the small intestine, eliminating potential sources of future complications.
2. Stricture Dilation: Strictures or narrowing in the small intestine can be dilated or stretched during DBE to relieve obstructions and improve the flow of food and liquids.
3. Stent Placement: In cases of blockages or strictures, stents can be placed to maintain the patency of the small intestine and alleviate symptoms.

How Double Balloon Enteroscopy Works

The DBE procedure begins with the patient receiving sedation to ensure comfort and relaxation. Here is an overview of the key steps involved:

1. Insertion: The endoscope, equipped with one balloon, is introduced through the mouth or rectum and guided into the small intestine.
2. Balloon Inflation: The balloon on the endoscope is inflated to anchor it in place, while the overtube is advanced further into the small intestine.
3. Advancement: The overtube is moved ahead, pushing the endoscope deeper into the small intestine.
4. Visualization: The endoscope provides real-time images of the small intestine’s lining, allowing the gastroenterologist to closely examine the tissue and identify any abnormalities.
5. Intervention: If polyps, tumors, or strictures are encountered, they can be treated during the procedure. This may involve removal, dilation, or stent placement, depending on the issue.
6. Biopsy: Tissue samples (biopsies) can be collected for further analysis if necessary.

What to Expect During a Double Balloon Enteroscopy

Before the procedure, you’ll receive specific instructions on preparation, which typically involves fasting and bowel preparation.

During the procedure:

• You will be given sedation for comfort.
• The procedure may take anywhere from 30 minutes to a few hours, depending on the extent of the examination and any interventions required.

After the procedure, you will be monitored until the sedation wears off. You may experience some mild abdominal discomfort, bloating, or cramping, which should subside within a day.

Recovery and Aftercare

The recovery period following a DBE is relatively short.

Patients are typically able to resume their regular diet and activities the same day, although some may prefer to take it easy for a day or two.

The results of the procedure and any biopsies taken will be reviewed by your healthcare provider, who will discuss the findings and any necessary treatment or follow-up plans.

What are the risks of DBE?

Double balloon enteroscopy (DBE) is generally considered a safe and well-tolerated procedure.

However, like any medical procedure, it carries some inherent risks and potential complications.

These risks are typically low but need to be considered. It’s important for patients to be aware of these risks and discuss them with their healthcare provider before undergoing DBE.

Some of the potential risks and complications associated with DBE include:

1. Bleeding: During DBE, biopsies may be taken, or polyps and tumors may be removed. In some cases, this can lead to bleeding. The majority of bleeding cases can be managed during the procedure, but there is a small risk of post-procedure bleeding, which might require further intervention.
2. Perforation: Although rare, there is a risk of a small tear or perforation in the lining of the small intestine. Perforations can occur during the passage of the endoscope or during therapeutic interventions like polyp or stricture removal. Perforations are typically managed with immediate medical attention and, in some cases, surgical repair.
3. Infection: Any time an invasive procedure is performed, there is a small risk of infection. To minimize this risk, DBE is performed in a sterile environment, and strict infection control protocols are followed.
4. Reaction to Sedation: Sedative medications are administered to keep the patient comfortable and relaxed during the procedure. While these medications are generally safe, there is a small risk of an adverse reaction, such as an allergic reaction or breathing difficulties. It’s crucial for the healthcare team to monitor the patient’s condition during the procedure to address any potential complications promptly.
5. Incomplete Examination: In some cases, it may not be possible to advance the endoscope through the entire small intestine. This can result in an incomplete examination and limit the ability to visualize certain areas of the small intestine. The reasons for an incomplete examination can vary, including anatomical factors or patient discomfort.
6. Post-Procedure Discomfort: Patients may experience mild abdominal discomfort, bloating, or cramping following the procedure. This discomfort is usually short-lived and should resolve within a day.

It’s essential for patients to discuss these risks and any specific concerns with their healthcare provider before undergoing DBE.

Healthcare providers will assess the individual’s medical history and determine the appropriateness of the procedure based on their unique circumstances.

Conclusion: Illuminating the Unseen with Double Balloon Enteroscopy

Double balloon enteroscopy is a remarkable advancement in the field of gastroenterology, providing healthcare providers with the means to explore and treat the small intestine.

With its diagnostic and therapeutic capabilities, DBE offers hope to individuals with small bowel conditions, including those with unexplained gastrointestinal bleeding, suspected tumors, or Crohn’s disease.

If you’re experiencing symptoms related to your small intestine or have been recommended for a DBE procedure, remember that this specialized tool can illuminate the unseen and pave the way for diagnosis, treatment, and ultimately, improved health and well-being.

Contact Dr. Deetlefs

Dr Eduan prides himself on his ability to help his patients to the best of his ability by embracing good listening skills, effective communication, compassion and knowledge and skill honed during years of private gastroenterology practice.

If you would like to book an appointment with a gastrointestinal (GI) specialist or would simply like more information on a particular GI topic, don’t hesitate to use our online booking form or call Dr. Deetlefs at 021 551 867.