Esophageal Self Dilation Therapy: An Effective Alternative

Jan 8, 2019 | Kanaaz Pereira, Connect Moderator | @kanaazpereira | Comments (16)

Many patients have difficulty swallowing due to narrowing of the esophagus. Benign esophageal strictures can be challenging to treat, with the main treatment being endoscopic dilations. Often, repeated upper endoscopies are required to maintain successful swallowing. These procedures are costly and their efficacy can be short-lived. Gastroenterologists at Mayo Clinic offer a more convenient and effective method that may lessen the frustrations and challenges of repeated endoscopies–esophageal self dilation therapy or ESDT.

Esophageal self-dilation involves teaching the patient how to dilate their esophagus orally, on a routine basis with the help of a simple medical device–a polyvinyl dilator. Besides being successful, researchers also found that ESDT could lead to the removal of feeding tubes that were previously required to get food into the gastrointestinal tract.

Mayo Clinic gastroenterologist, Dr. Magnus Halland, M.D., encourages patients with swallowing difficulties due to narrowing of the esophagus, to visit Mayo Clinic to see if they may be candidates to learn ESDT. Dr. Halland also talks about the open clinical trial linked to ESDT at Mayo Clinic.

Meet other people talking about esophageal disorders on Mayo Clinic Connect. Here are some discussions you might like to view–join the conversation, share experiences, ask questions, and discover your support network...

Interested in more newsfeed posts like this? Go to the Gastroenterology & GI Surgery blog.

My husband will be having this done for the 2nd time. We cannot imagine this being done by anyone except a professional and under anesthesia.

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@walisky

My husband will be having this done for the 2nd time. We cannot imagine this being done by anyone except a professional and under anesthesia.

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Best wishes for your husband. It is fortunately only a small group of patients who simply don't stay open very long after endoscopic dilatations done under anesthesia. In such patients, many of whom have undergone 10 or more endoscopies, we teach self-dilation, which helps maintain the opening which has recently been achieved during an endoscopic procedure.

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3 years ago I started having problems with food getting 'stuck' – at times it wouldn't go down my esophagus and would eventually come back up. It gets better at times and worse at others.

In the last 6 months I have had difficulty breathing, feeling like it is difficult to get air down my throat. I'm starting to panic a little, worried that I will suffocate. Sometimes it seems mostly ok, at others I feel a complete restriction on air intake may occur. In the last month it has gotten especially bad.

I have many symptoms of hypothyroidism and a family history of it, so a nodule or other related obstruction may be the cause. I also have acid reflux issues and a family history of GERD, so perhaps that is it. Maybe it is something else…

I lost my insurance after a lay off a few years ago. I have a new job but no insurance for now. I do not have much money. I cannot afford to go to a doctor. Is there a way by which I can get the dilator needed to do this at home?

I'm getting desperate and was thinking of trying to construct something to do this in an emergency, which is how I found this article. I am in the Northern suburbs of Dallas, TX.

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My wife could benefit from this type of treatment. We do not live in the area of any of the participating clinics. How could we go about getting something like this for her?

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I am very interested in this. I found your video on YouTube while trying to see if there are any new developments in this surgery or condition. I have had the dilation done about 5 times within 17 to 33yrs old. The last time being about 4 years ago and I can’t stand the choking much longer. Iv been toughing it out but this year I broke my hand so I’ve maxed out my deductible and would like it done again.
I live in Utah so I’m not close to your clinic. Is there any advice you could give or point me towards?

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My husband had chemo/radiation treatment for 3rd stage non small cell lung cancer. At the end of treatment he was put on a PEG tube due to inability to swallow. Two months after radiation was completed the GI doctor attempted an endoscopy and was unsuccessful due to blockage. We were advised he would likely be on a feeding tube the rest of his life. The oncologist was very dissatisfied with his outcome and found a thoracic surgeon at U of M in Ann Arbor MI who was skilled in the antegrade/retrograde endoscopy or CARE. The surgery was a success clearing the stricture and he is open now. He was sent home with a self dilator and instructed to do it daily for 30 days, go to every other day and then weekly. We are a success story and are so thankful for this method!

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I have had the procedure done 10 times in the past 14 months and about 6 weeks is about as far as I can go before the restriction is substantial. I had Tonsil Cancer and had 35 rounds of radiation which is what is causing my stricture. I am moving towards self dilation right now. My GI doctor has heard of it and willing to teach me. Of course I will have to waive everybody on the planets responsibility but I am thinking I can do it and it would be best for me. Crazy thing is I have found the Bougie Maloney and Hurst of all sizes on Ebay. If my insurance will not pay for the device I will order one from there I suppose.

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I posted a comment above about my desire to do the self dilation and wanted to ask what size others were using? My GI doctor currently uses a 48 on me and I was hoping to follow up with a size smaller in self dilation. Is that to aggressive?

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We have been using a size 46 for about a month and a half. Do you have someone to help you with it? The doctor showed us how to do it but we have discovered a few small things that make it go so much easier! It takes a total of 20 seconds start to finish and the trade off is normal swallowing!

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@jmfarris

We have been using a size 46 for about a month and a half. Do you have someone to help you with it? The doctor showed us how to do it but we have discovered a few small things that make it go so much easier! It takes a total of 20 seconds start to finish and the trade off is normal swallowing!

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Yes my GI doctor is willing to help me. We are currently looking into how to go about getting the device (I have actually found them in different sizes on ebay new and used if you can believe that) and if Insurance will cover it. I plan to do it regardless. I too feel it will help me stay open more regular instead of stretching and closing over and over. My doctor is currently using a 48 but has gone bigger in the past. He says he thinks the 48 is a good size for clear passage. I hope to end up using the 48 daily or weekly but may start with a size or two smaller. Could you share with me the small things you have discovered to make it go smoothly for you? I watched a very helpful video on youtube but they will not let me post a link. You can find it by searching Esophageal Self Dilation it is by MarletteAcres

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@rlp63

Yes my GI doctor is willing to help me. We are currently looking into how to go about getting the device (I have actually found them in different sizes on ebay new and used if you can believe that) and if Insurance will cover it. I plan to do it regardless. I too feel it will help me stay open more regular instead of stretching and closing over and over. My doctor is currently using a 48 but has gone bigger in the past. He says he thinks the 48 is a good size for clear passage. I hope to end up using the 48 daily or weekly but may start with a size or two smaller. Could you share with me the small things you have discovered to make it go smoothly for you? I watched a very helpful video on youtube but they will not let me post a link. You can find it by searching Esophageal Self Dilation it is by MarletteAcres

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We were fitted with ours by a thoracic surgeon who specializes in esophageal strictures amongst other things. We use a 46 and so far it’s been a life saver.
We insert up to the white 35 mark as directed by the doctor. I coat the dilator with KY jelly. My husband takes a few deep breaths and I lay it on his tongue and direct him to swallow. As soon as he swallows I know it’s going in correctly and I ease it down quickly until the 35 is at his lip. As it’s going down I coach him to breathe around it, very important not to hold your breath! Then I count to 10 and pull it out. The whole thing takes 20 seconds and the swallow has to be timed exactly right to when I start easing it down. You should not have to push!
You may want to look at a product on Amazon called Healios, it’s made by a doctor and provides nutrients to the esophagus for people who’ve had radiation. My husband finds it soothing before or after dialsting.
Hope this helps

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Thank you. My wife is a nurse and she will be present when my doctor teaches me and I hope her experience in the medical field will help. My speech therapist (swallow therapy) actually told me about Healios but I haven't tried it. I will try to get on here and update after I learn. 🙂

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