Treatment Options: Dilatation
Mosher bag dilatation is aimed at stretching the circular muscle of the lower esophageal sphincter area in order to break apart the muscle fibers. If the muscle fibers do not break apart the procedure will not work. The lower esophageal sphincter will return to its abnormal, contracted state and will not allow food to pass. However, if the circular muscle fibers do break, then the lower esophageal area will no longer be able to contract and the patient will be able to swallow.
During the procedure, a narrow tube is passed through the mouth and into the esophagus. An endoscope is also passed down the esophagus so the doctor can locate the area of narrowing and directly observe the procedure. The dilating tube contains a strong balloon which is inflated while its pressure is monitored. The patient can resume a normal diet 6 hours after the procedure.
What are the results?
Approximately 60 to 80 percent of patients who undergo a dilatation will have good to excellent results in which there is no or minimal difficulty swallowing. Approximately 60 percent will remain well one year later, but that percentage drops to about 50 percent 5 years after the procedure.
Fortunately, patients who initially respond well to dilatation usually respond well when the procedure is repeated. Approximately 20 percent of patients undergoing this treatment will require more than one dilatation to achieve good to excellent long-term results. In contrast, patients who do not respond well the first time are unlikely to respond to a second dilatation. It is important to realize, however, that it may take up to one month for the treatment to work.
What are the risks?
The principal risk of pneumatic dilatation is perforation of the esophagus. This occurs less than 5 percent of the time. Although many patients with perforation do not require surgery, perforation can be life-threatening. Perforation is suspected when chest pain, back pain, repeated vomiting and/or a rapid heart rate occur after the procedure. For this reason, patients are observed for six hours after the procedure. Other complications are uncommon and usually insignificant. These include bleeding and a blood clot in the wall of the esophagus.
A final complication that must be considered is the development of reflux or gastro-esophageal reflux disease after successful dilatation. Most patients will experience some degree of reflux following the procedure but only a few will develop symptoms of heartburn and chest pain.