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Esophageal Dilation



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Can anyone tell me exactly what is esophageal dilation and what the complications are from it? My doctor said that I was starting to dilate when he filled me up with the help of a floroscope.

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my understanding is that when you eat too much, the esophagus starts to fill up and dilate. Is that correct banders??

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It means you have been over-eating, with the excess food (the "overflow" from the pouch) builds up and stays some time in the lower esophagus - which then relaxes and stretches to accommodate this extra food. When it happens on a consistent, often repeated basis, the dilatation would become constantly present. As far as I know, it is reversible. I have heard of it being treated by an unfill and restriction of intake to liquids and mushies for a period of time.

You should call your doctor's office and say that you want to know WHY your dilatation happened and what you can do to get rid of it.. Since I'm not a doctor and only know what I have learned online -- which is not much. :)

Theresa

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Your esophagus takes on the role of a stomach, holding food and not acting like a muscle pushing it through. If this continues and it gets worse you could end up with what is called a dead esophagus. The only way to make that better is remove the band and in some cased replace your esophagus with a portion of your colon. Major surgery.

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Could you have this without being banded? I'm not banded and feel like there is food in it when I overeat.

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Not exactly what youre looking for, but came across it in some of my research.

What is a slipped Band, and what causes it?

There are two types of slippage; anterior and posterior. This refers to whether the front or back side of the stomach slips. There is something else called concentric pouch dilation, but this is not the same as slippage. Slippage or prolapse is when the stomach slides up through the Band, making the pouch bigger. If this happens the Band usually becomes too tight, and patients experience symptoms of reflux (heartburn) as well as nausea and vomiting. This is because the amount of stomach being “squeezed” by the Band is increased, thereby obstructing the Band.

There are several causes. Posterior slippage was more common when the Band was placed by the “perigastric” technique. With this technique the back side of the stomach was free to slide up through the Band. These days most surgeons use the “pars flaccida” technique, which was developed to prevent posterior slippage, and has more or less eliminated the incidence of this problem.

Anterior slippage is when the front of the stomach slips up through the Band. We try to prevent this by suturing the stomach below the Band to the stomach above the Band, “locking” the Band in place in the right spot. In spite of this, slippage still occurs. It can happen because we haven't placed enough stitches, or they haven't been placed in the right place. Slippage can also occur if patients eat too much and vomit frequently.

How is a slipped Band diagnosed?

Fortunately, this is very easy. Often the diagnosis is made based on the history alone. A patient who has been going along fine, with no problems, and then suddenly develops reflux symptoms or symptoms of a too-tight Band will most likely have a slipped Band. The diagnosis is easily confirmed with an x-ray and barium swallow examination. Endoscopy is rarely necessary.

How is a slipped Band fixed?

A slipped Band needs to be fixed with an operation. The Band has to be dissected out, all the sutures removed, and the position of the stomach made right. Some surgeons remove the Band and place it back through a new tunnel. Others just straighten things out and re-suture the stomach over the Band.

What happens if the Band slips again?

That's a tough one. One could certainly try to fix the slip again, but my personal view is that, for whatever reason, the Band is just not working for that particular patient, and ought to be removed.

What is a Band erosion?

This is when the Band actually erodes into the stomach. It is a more serious problem, and generally requires removal of the Band. Band erosion is thought to be related to placing too many sutures (or too tight sutures) at the time of Band implantation. Surprisingly, Band erosion is often unnoticed. Occasionally the port will become infected if bacteria track along the catheter out to the port. Other times patients will stop losing weight. Diagnosis often requires an endoscopy.

What is concentric pouch dilation?

This is technically not the same as slippage. In this case the pouch just seems to be enlarged. Sometimes partial emptying of the Band may help with this.

What is esophageal dilation?

This is when the esophagus enlarges over time, and is probably related to either too tight a Band, or possibly improper placement of the Band around the junction of the esophagus and stomach. This requires loosening or removal of the Band.

What happens if my Band has to be removed because of complications or failure to lose weight?

One option, of course, is to give up on weight loss surgery. Another option is to convert to another procedure such as Roux-en-Y gastric bypass. This can be done at the same time the Band is removed, and is generally done laparoscopically.

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It means you have been over-eating, with the excess food (the "overflow" from the pouch) builds up and stays some time in the lower esophagus - which then relaxes and stretches to accommodate this extra food. When it happens on a consistent, often repeated basis, the dilatation would become constantly present. As far as I know, it is reversible. I have heard of it being treated by an unfill and restriction of intake to liquids and mushies for a period of time.

You should call your doctor's office and say that you want to know WHY your dilatation happened and what you can do to get rid of it.. Since I'm not a doctor and only know what I have learned online -- which is not much. :D

Theresa

Thats HORRENDUS!!!

It is not solely down to "over eating" and streaching the pouch!!

It can be down to the band being placed too high around the stomach and THE WAS NEVER A POUCH! thats why one will develope in the oesopigus (spelling sorry)

It can also be the band to too tight

The most likely reason is the band was missplaced to start with and because it was positioned too high the oesopigus has become the pouch.

chances are the surgeon WONT admit to making the mistake and the patient will be blamed.

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Matzatl,

Chronic pouch dilation is the most likely culprit of esophageal dilation because once someone chronically overeats, the pouch fills up and the food has no where else to go but the esophagus. Essentially you would be using your esophagus as a third pouch. Esophagus, upper pouch/ lower stomach.

Other causes of esophageal dilation could be esophageal dysmotility (which means that your esophagus is not pushing food through properly), too tight band, band placement (which is not the likely cause but it could happen).

Most docs will do a complete unfill and let the esophagus and pouch go back to normal size. Chronic pouch packing/dilation can cause a slip, esophagus problems etc. THe best thing you can do to prevent these problems is to watch your food portions and keep them to 3-4 oz of solid Protein and a few ounces of veggies/carbs per meal.

I speak from experience. I had my band emptied in August and refilled in mid September due to esophagus dilation and pouch dilation. I am much more aware of quantities now.

Babs in TX

334/190 ish

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Matzatl,

Chronic pouch dilation is the most likely culprit of esophageal dilation because once someone chronically overeats, the pouch fills up and the food has no where else to go but the esophagus. Essentially you would be using your esophagus as a third pouch. Esophagus, upper pouch/ lower stomach.

Other causes of esophageal dilation could be esophageal dysmotility (which means that your esophagus is not pushing food through properly), too tight band, band placement (which is not the likely cause but it could happen).

Most docs will do a complete unfill and let the esophagus and pouch go back to normal size. Chronic pouch packing/dilation can cause a slip, esophagus problems etc. THe best thing you can do to prevent these problems is to watch your food portions and keep them to 3-4 oz of solid Protein and a few ounces of veggies/carbs per meal.

I speak from experience. I had my band emptied in August and refilled in mid September due to esophagus dilation and pouch dilation. I am much more aware of quantities now.

Babs in TX

334/190 ish

And the band being placed to high!! its a fact surgeons SOME place them too high.

And i cant help but laugh but isnt the band's whole pirpose to restrict portion size? with out sounding synical??

i really am not anti band but when these probs happen it staggers me that people can't understand them and why they happen.

Everything about Obesity is = cronic over eating = bad food choices = not chewing properly = greed = emotional eating = large portion sizes, I mean what makes the band change all these things? For some the changes are just really hard to make infact so hard if they could change they would change. thats why over and over again people fail with diets for some the band is just another diet thats hard to stick to. Its just not suatable for every one and these complications Should be half solvable by identifing who is likely to fail by lifestyle questions and monitering.

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HI Paige,

My band is placed properly and is confirmed by endoscopy, flouroscopy and every other test known to man. I was too tight but I did not have reflux or any other problems asssociated with a too tight band, so the docs kept filling it. Yeah, I would like more restriction, but it seems that my ability to pouch pack means I need to keep the band a little looser than I would like, but it is helping me by taking the edge off the hunger and the overeating. The rest I will do for myself with diet and exercise.

The band is not rocket science. IT is either too tight, too loose or just right. I had my band accidentally unfilled when I had plastic surgery last year and gained significant weight while they tried to adjust it back to the same level of restriction that I had before. I am back on track and I have lost 20 lbs of the 38 pounds I gained over a year and a half.

It is true that I did not notice that I was slowly eating more and more, but I knew I was eating too much and didnt listen to the signals since they were not as strong as they were when I was originally banded. I lost most of my weight in the first 18 months and noticed the diminishing restriction. I kept pushing the bar just a little more everyday and pretty soon, I was eating normal portions and not getting full.

FYI: You can also pouch pack with a RNY causing the pouch to enlarge and no longer be effective in creating satiety. You can sabotage any WLS if you really put your mind to it.

You keep saying that you dont mean to be negative, but you are and I find it disturbing.

Babs in TX

334/190 ish

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Dont be disturbed by my negativity, I guess i just have a differnt out look on it.

I dont think when people come across this op they know enough and i think people are too fearfull to be honest about probs they have had because of situations like this were a poster is made to look negative.

You have arguments to what i say but your not actually saying what im saying is not true! ok while what i say is not popular bad news never is. It os how ever true and while these complications may be rare when they happen they can really distress the person experiencing them.

What i say is true just not popular.

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totally agree about the bypass, I think this is my personal opinion.

in some cases funds are too easily available and not enough research is done and thngs are rushed into.

I just want to offer emotional support to people suffering complications because, there is only so many times one can say stick to liquids for a while or have a unfill. I think once the probs set in there really tricky to sort out and it developes into a cycle of trying this trying that and with all the probs you have sufferd you have also benafited from weight loss.

some dont have that and with all the niggles there band brings they cant even seem to lose the weight and ontop of band probs they still have the weight issues, then emotional problems because of the whole cycle.

Thats all im really trying to say is yep these probs happen so you may have over eaten i dont think your bad i think its understandable because you have a history and the band is just something you tried and struggled with.

Sometimes the benafit of the weight loss actually pays off all the complications makes it worth it. But when you dont even have that and just cant seem to manage it its devastateing. And your right when people search for support no one wants to listen to it.

Well i do and i feel for you.

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Dear Paige, I had my band fitted in August 05 and quickly lost a lot of weight. I was nearly 20 stone (approx 280 pounds) for the op and went down to 144 pounds, by august 06.

As I had the op in Hungary I decided to have a fill with your Dr Super, over at Solihull. He didn't actually do the fill himself , just the initial interview. His report was sent to my own Dr in Harborne. In it he said that my band was in the wrong place and that I would have trouble swallowing and would never feel full. Since then , despite my weight loss, I've been very depressed and have gained 10 pounds. I now seem to be able to eat what I like and I feel like a huge failure.

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