Patient guide · Gastroenterology
Upper GI endoscopy and dilatation, therapeutic OGD with balloon or bougie dilatation of the oesophagus.
Upper GI endoscopy with dilatation combines a diagnostic OGD with therapeutic balloon or bougie dilatation of oesophageal strictures — for dysphagia, achalasia, peptic strictures and Schatzki rings. Same-day discharge under conscious sedation.
Why patients choose us
- 01
The right hands
A consultant gastroenterologist with a therapeutic upper GI list — the person who scopes you is the person who dilates you.
- 02
Often answers same-day
Findings and the immediate dilatation result are discussed on the day, with the written report to follow.
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Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Key facts
Upper GI endoscopy and dilatation at a glance.
The six things worth knowing before you scroll further — definition, day-case status, combined diagnostic and therapeutic reach, dilator choice, repeat sessions and manometry’s role in achalasia.
- 01
Definition
Therapeutic OGD combining diagnostic upper GI endoscopy with balloon or bougie dilatation of an oesophageal stricture.
- 02
Day-case under conscious sedation
Performed as a day case with IV conscious sedation and throat spray — home the same afternoon.
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Combines diagnostic OGD + therapeutic dilatation
One session inspects the upper GI tract, biopsies suspicious mucosa and dilates the stricture.
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Balloon or bougie dilator
Through-the-scope balloon or wire-guided Savary bougie — chosen for stricture length, tightness and aetiology.
- 05
Repeat sessions often needed
Benign strictures commonly need a series of dilatations, spaced weeks apart, to reach a durable lumen.
- 06
Complements manometry for achalasia
In achalasia, oesophageal manometry defines the disease and dilatation, Botox or POEM treats it.
Preparation and pathway
From consultation to structured plan — what happens, in order.
One consultant gastroenterologist from first appointment to structured report — usually within a week.
Phase 1 · Before your scope
Consultation and fasting
Phase 2 · On the day
Sedation, OGD, dilatation
Phase 3 · After
Report and structured plan
- 01
Before
Gastroenterology consultation
A consultant reviews your dysphagia history, prior imaging or endoscopy, and confirms therapeutic OGD is the right step.
- 02
Before
Fasted 6 hours
Six hours no food and two hours no clear fluids before the procedure. Written instructions provided.
- 03
On the day
IV sedation + throat spray
Midazolam and fentanyl for conscious sedation, with topical throat spray for comfort.
- 04
On the day
Diagnostic OGD
Systematic inspection of the oesophagus, stomach and duodenum, with biopsies where indicated.
- 05
On the day
Balloon or bougie dilatation
Graduated dilatation of the stricture to the planned diameter — through-the-scope balloon or wire-guided bougie.
- 06
On the day
Repeat OGD to confirm patency
Post-dilatation inspection to confirm lumen, check for mucosal tears and exclude perforation.
- 07
After
Structured plan
A consultant-issued report with images, histology follow-up, PPI plan and the interval to the next dilatation if needed.
Typical end-to-end: 3–7 days. Urgent cases: same week.
What it shows
The strictures upper GI dilatation treats.
The presentations therapeutic OGD is designed for — with the red-flag pathway called out separately.
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Peptic stricture
Fibrotic narrowing from long-standing reflux, dilated and treated with PPIs.
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Schatzki ring
Lower oesophageal mucosal ring, often responsive to a single dilatation.
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Achalasia
Pneumatic dilatation of the lower oesophageal sphincter for motility failure.
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Post-radiotherapy stricture
Late fibrotic narrowing after chest or head-and-neck radiotherapy.
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Anastomotic stricture
Post-surgical narrowing at an oesophagogastric or gastric anastomosis.
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Caustic stricture
Long, tight strictures after caustic ingestion — often need serial dilatation.
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Eosinophilic oesophagitis stricture
Fibrostenotic narrowing in EoE — dilated cautiously alongside topical steroid therapy.
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Red flag: post-dilatation perforation — urgent surgery
Chest pain, surgical emphysema or sepsis after dilatation triggers immediate imaging and surgical referral.
Next steps
What happens after dilatation.
The eight most common next steps — from repeat dilatation and PPI cover to Botox, pneumatic dilatation, POEM and MDT review.
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Repeat serial dilatation
Benign strictures usually need staged dilatation over several sessions to reach a durable diameter.
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PPI for peptic stricture
Long-term proton pump inhibitor therapy to prevent re-stenosis after peptic-stricture dilatation.
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Steroid injection (refractory)
Intralesional triamcinolone at dilatation for refractory strictures that keep recurring.
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Botox for achalasia
Endoscopic botulinum toxin into the lower oesophageal sphincter — useful in frail patients.
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Pneumatic dilatation for achalasia
Graded large-diameter balloon dilatation of the LOS — durable in appropriately selected patients.
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POEM (per-oral endoscopic myotomy)
Endoscopic myotomy of the LOS for achalasia and selected spastic motility disorders.
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Structured gastro follow-up
Planned review to reassess symptoms, review histology and set the next dilatation interval.
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MDT review
Multidisciplinary discussion for suspected malignant, refractory or post-surgical strictures.
Red flags
When upper GI dilatation shouldn’t wait.
The nine situations that push therapeutic OGD up the queue — including post-procedure complications and suspected malignancy.
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Post-dilatation perforation
Severe chest pain, surgical emphysema or sepsis after dilatation — urgent CT and surgical referral.
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Post-procedure sepsis
Fever, tachycardia or rigors within 24 hours of dilatation warrant urgent assessment.
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Post-procedure haemorrhage
Haematemesis or melaena after dilatation — return to hospital and consider re-scope.
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Refractory achalasia
Persistent dysphagia despite dilatation or Botox — POEM or Heller myotomy considered.
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Suspected malignant stricture
Asymmetric, ulcerated or rigid strictures require biopsy and staging before any dilatation.
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Post-radiotherapy stricture
Higher perforation risk — dilated cautiously in centres with the relevant experience.
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Caustic ingestion stricture
Long, tight and often multiple — dilatation only in specialist upper GI units.
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Post-surgical anastomotic leak
Suspected leak before or after dilatation is a surgical emergency, not a repeat scope.
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Barrett’s stricture with dysplasia
Stricture overlying dysplastic Barrett’s needs expert mapping biopsies and MDT review.
Reading your report
A therapeutic OGD report can look intimidating. It isn’t.
Whatever the finding, the report keeps to the same four parts.
A quiet reminder
The report is written for your doctor, not for you — and that’s normal.
If you would like us to talk you through it before your follow-up, just ask.
- 01 Header
Indication and stricture history
Your details, the reason for therapeutic OGD, prior dilatations and current dysphagia grade.
- 02 Technique
Sedation, scope and dilator used
Sedation regime, scope type, dilator (balloon or Savary bougie), diameters achieved and any adjunctive therapy.
- 03 Findings
Stricture description and biopsies
Location, length and tightness of the stricture, mucosal appearance, biopsies taken and any therapeutic manoeuvres.
- 04 Impression
The conclusion — read this first
Diagnosis, immediate result of dilatation, PPI or medical plan, and the interval to the next session or follow-up.
Recognised by major UK insurers
Cover depends on your policy and clinic; we confirm with your insurer before booking.
Frequently asked
Everything we get asked about upper GI dilatation.
Quick answers on fasting, balloon vs bougie, repeat sessions, risks and where dilatation sits in achalasia care.
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What is upper GI endoscopy with dilatation?
A therapeutic OGD in which a consultant gastroenterologist inspects the oesophagus, stomach and duodenum, and then dilates a narrowed segment of the oesophagus using a through-the-scope balloon or a wire-guided Savary bougie — all in one session.
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Do I need to fast?
Yes. Six hours no food and two hours no clear fluids before the procedure. Written instructions are provided in advance, including how to handle your usual medications.
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Balloon or bougie — what is the difference?
A balloon dilator is passed through the scope and inflated radially at the stricture. A Savary bougie is a tapered plastic dilator passed over a guidewire, applying longitudinal shear. Choice depends on stricture length, tightness and aetiology.
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Will I need repeat dilatations?
Often yes. Benign strictures — peptic, post-radiotherapy, anastomotic and caustic — usually need a series of dilatations spaced weeks apart to reach a durable lumen, with the interval driven by your symptoms.
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What are the risks?
The most important risk is perforation of the oesophagus, which is uncommon but serious. Bleeding, transient chest pain and post-procedure sore throat are more common and usually self-limiting.
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Is dilatation the right treatment for achalasia?
Pneumatic dilatation is one of three established treatments for achalasia, alongside Heller myotomy and POEM. High-resolution oesophageal manometry defines the subtype and guides which is right for you.
Sources
The guidance behind this guide.
- British Society of Gastroenterology. Guidelines on the management of oesophageal strictures.
- American Society for Gastrointestinal Endoscopy. Guidelines on endoscopic dilatation.
- European Society of Gastrointestinal Endoscopy. Clinical guidelines.
- NICE. Dyspepsia and gastro-oesophageal reflux disease (CG184).
Reviewed 2026-07-30 by Pulse Atlas Editorial Board, . Next review 2027-07-30. Estimated reading time 5 minutes.
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In practice, in London
How upper gi endoscopy and dilatation tends to unfold when you go private
With upper gi endoscopy and dilatation, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. Public provision for upper gi endoscopy and dilatation is competent but constrained by capacity. Private London clinics tend to have shorter diaries and longer appointment slots, so you get the same specialists with more time. For people who’ve been going round in circles with primary care, that first proper conversation is often what shifts things.
Once you’re in the private system for upper gi endoscopy and dilatation, the pace picks up noticeably. Consultant slots run to time, imaging is usually available in the same building or a short walk away, and the report comes back typed and detailed. It’s the coordination that tends to feel different — one person on the other end of the phone, not a switchboard. For upper gi endoscopy and dilatation specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
Fit matters more than people expect. For upper gi endoscopy and dilatation, the right consultant depends on what you actually need — a second opinion, a definitive diagnosis, a bridge into treatment, or reassurance that nothing’s being missed. We match on that, not on who has the biggest brochure. If a test isn’t the right next step, we’ll say so before you book anything.
Nearby in the library