Feasibility of Awake In-Office Transnasal Double Balloon Dilation of the Pharyngoesophageal Segment

To review experience with and describe the feasibility of unsedated in-office transnasal double balloon dilations of the pharyngoesophageal segment (PES).

Adults who underwent office-based transnasal double balloon dilations of the PES at a single academic institution over a 3-year period were retrospectively studied. Clinicodemographic data, prior PES dilation history, procedural indications, pre-procedure anxiolytic usage, procedural data including the number of office-based double balloon dilation procedures performed and dilation diameter, complications, and subjective outcomes at 2 weeks post-dilation were recorded.

Nineteen office-based double balloon dilations to 24 mm (12 + 12-mm balloons) were performed in seven patients (mean age: 65.3 years, 57.1% female). Indications for dilation were varied. Two (28.6%) patients had a history of oropharyngeal cancer treated with radiation therapy. No patients were post-laryngectomy. The majority (85.7%) of patients underwent at least one prior in-office transnasal single balloon dilation. Two (28.6%) patients required a pre-procedure anxiolytic. One complication occurred involving post-procedure epistaxis that resolved with topical oxymetazoline application. No esophageal lacerations or perforations were encountered. No procedures required early termination due to poor patient tolerance. The majority (71.4%) of patients reported subjective improvement in dysphagia symptoms at 2-week follow-up.

Double balloon dilation of the PES is feasible in unsedated patients in the office setting.