Esophageal Balloon Dilation in Dogs

Esophageal balloon dilation treats esophageal strictures. These occur when a foreign object becomes stuck in the esophagus and causes it to narrow. They may also be attributed to the slowed peristalsis reaction caused by the administration of general anesthesia. The stricture is the scar tissue left behind on the esophageal lining due to persistent irritation. Dogs with esophageal strictures cannot typically swallow food. Depending on the severity of the stricture, swallowing water may also prove difficult. Esophageal balloon dilation is usually performed over several sessions, especially in cases where multiple strictures are present.

Balloon dilation is often performed over multiple sessions. Two to four sessions will take place over two to three days. However, the number of sessions will vary based on the nature of the stricture and the dog’s response to treatment. Each session will require anesthetization. The procedure steps for a single treatment session are outlined below.

1. Blood work, x-rays, and urinalysis are conducted prior to surgery to identify the stricture and ensure anesthetization is safe for the dog.
2. General anesthesia is administered. 
3. An endoscope is inserted into the esophagus. This allows the veterinarian to visualize the stricture(s).
4. The balloon dilator is inserted through the endoscope and placed in the middle of the stricture.
5. Dilation then begins after an injection of a sterile saline solution.
6. The dilation stretches the narrowed esophagus.
7. The endoscope and balloon dilator are then removed.
8. If the dog is unable to eat or drink on its own, it may be hospitalized until treatment is completed. During this time, a feeding tube will be placed.

The efficacy of esophageal balloon dilation will vary based on the severity of the stricture and the number of sessions performed. However, it is considered the most successful, and most readily available, technique for treating esophageal strictures. Other treatment methods include bougienage, esophageal stents, surgery, and corticosteroids. Additionally, signs of esophagitis often linger even after the procedure is complete, and will need to be treated with medication and dietary changes.

On the return home, the dog should be placed on a soft-food diet. Antacids may be prescribed if the esophageal strictures are attributed to anesthesia. Drugs to treat signs of esophagitis will be prescribed as well. These may include esophageal coating agents, gastrointestinal motility medications, antibiotics, and analgesics.

The cost of esophageal balloon dilation will vary based on standards of living and additional treatments required. The price of esophageal balloon dilation ranges from $800 to $4,000. This may or may not include the costs of diagnostic and laboratory testing, hospitalization, anesthetization, and medications.

Although it is the most successful treatment method, esophageal balloon requires several separate anesthetizations over a short period of time. This can be dangerous for older dogs. Esophageal balloon dilation is also associated with several complications, which include, but may not be limited to:

• Tearing of the esophageal lining
• Diverticula formation: Hollow, pouch-like sacs that cause additional complications
• Aspiration pneumonia
• Perforation of the esophagus

Aspiration pneumonia and esophageal perforation are rare but serious, potentially life-threatening complications of this procedure. The placement of a gastronomy tube may also cause complications, particularly septic peritonitis. However, esophageal tears and diverticula formation are less likely to occur with balloon dilation compared to other techniques, particularly bougienage.

In some cases, general anesthesia may actually cause esophageal strictures. Anesthesia slows down the dog’s peristalsis reaction, which pushes stomach acid and other contents of the esophagus back into the stomach. This means that stomach acid may remain in the esophagus for much longer than normal. This contact can cause strictures. In fact, 65% of esophageal strictures are caused by anesthesia. This complication is combated with antacid therapy, which should be started prior to the procedure and continued throughout. Certain sedatives and anesthesia agents are associated with lower risk of esophageal side effects.

Your veterinarian will discuss all possible risks and complications of this procedure with you prior to treatment.

Do not allow your dog to swallow foreign bodies that may cause esophageal strictures. Keep small objects and toxic chemicals out of reach of pets at all times. If you notice signs of persistent regurgitation, you should consult your veterinarian immediately, since this can indicate esophagitis. Regurgitation appears similar to vomiting. However, regurgitation may occur several hours or even several days after eating, while vomiting typically occurs almost immediately after eating.