Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Dilation of Esophagus


Related Terms

  • Balloon Catheter Dilation of Esophagus
  • Bougie Dilation of Esophagus
  • Esophageal Bougienage
  • Esophageal Expansion
  • Sound Dilation of Esophagus

Specialists

  • Gastroenterologist
  • General Surgeon
  • Internal Medicine Physician
  • Thoracic Surgeon

Comorbid Conditions

  • Immune system disorders

Factors Influencing Duration

Factors affecting duration include the underlying condition, severity of symptoms, and existence of complications related to the procedure.

Medical Codes

ICD-9-CM:
42.92 - Dilation of Esophagus; Dilation of Cardiac Sphincter

Overview

Dilation of the esophagus is a procedure that stretches the esophagus after it is narrowed by injury or disease. A series of dilators of increasing diameter are passed down the esophagus, usually in several sessions.

The most common conditions treated with dilation include stricture from reflux of gastric acid (a consequence of gastroesophageal reflux disease [GERD]), thin membranes that typically occur in the mid or upper esophagus (esophageal webs or rings), caustic injuries to the esophagus, the inability of the muscles in the lower esophagus to relax (achalasia), scleroderma, and narrowing of the esophagus due to esophageal cancer.

Source: Medical Disability Advisor



Reason for Procedure

Esophageal dilation is used to stretch an esophagus when narrowing (strictures) caused by scar tissue, tumors, inflammation, or overactive musculature prevents normal swallowing and results in difficulty swallowing (dysphagia).

The most common indication for esophageal dilation is stricture of the esophagus produced by reflux of gastric acid due to lower esophageal sphincter dysfunction. Other reasons for dilation include removal of thin membranes that typically occur in the mid or upper esophagus (esophageal webs or rings).

Caustic injuries to the esophagus may result from ingestion of corrosive substances (including acids, lye, strong bases, and industrial chemicals). After recovery from the initial injury, scar tissue often forms that can cause narrowing, or strictures, of the esophagus. Careful dilation can relieve this narrowing.

In achalasia, another form of esophageal sphincter dysfunction, the muscles in the lower esophagus are unable to relax. When medical treatment fails, dilation stretches and weakens these muscles so that improved swallowing can occur.

Scleroderma is a rare connective tissue disorder affecting almost all body tissues, especially the skin. The esophagus can become narrowed in this condition due to scarring. Dilation is often used to open the esophagus in this condition.

Esophageal cancer can narrow the esophagus so that swallowing is difficult. Although esophageal cancer is usually treated with surgery, palliative dilation may provide some relief.

Source: Medical Disability Advisor



How Procedure is Performed

Esophageal dilation is an outpatient procedure. The individual is usually given a sedative to decrease discomfort. Prior to the dilation, the individual must not eat for at least 8 hours. Under sedation, a fine, flexible viewing tube (endoscope) is passed through the mouth and down the esophagus, allowing visualization of the area to be stretched. Sometimes the individual swallows a length of thread that becomes anchored in the intestine. A metal guide is then passed down over the string.

Different types of dilators are available. The most common type involves the use of cylindrical rods with olive-shaped tips (bougies) of increasing size that are passed down over the guide wire, stretching the narrowed area. Another method involves the use of a fine tube with a balloon at the tip (balloon catheter). Instead of a guide wire, the tube may be used alongside the endoscope, passed through the scope, or used alone, guided by images on a fluorescent screen (fluoroscopy). When it reaches the narrowed area of the esophagus, the balloon is inflated and kept in position for 3 minutes. It is then deflated and withdrawn. The procedure may then be repeated with a larger balloon.

Source: Medical Disability Advisor



Prognosis

Early improvement in the ability to swallow is achieved in nearly all patients (ASGE). Longer-term outcomes depend on the underlying pathology. In patients with benign peptic strictures, if a luminal diameter of 13 – 20 mm can be achieved 85% to 93% will experience relief (Riley). In most conditions in which stricture or narrowing is the major component, such as achalasia, caustic injuries, or scleroderma, repeated dilations are likely necessary (ASGE).

Esophageal webs and esophageal rings may be treated with only a few dilations, possibly leading to long term relief.

Esophageal cancer is an extremely morbid condition usually best treated with surgical resection. If resection is not possible, dilations can be used to relieve the difficulty of swallowing. In end-stage esophageal cancer when death is inevitable, dilations are intended to relieve discomfort (palliative).

Source: Medical Disability Advisor



Complications

Esophageal dilation has a complication risk of 0.1% to 0.4% for perforation (Hernandez) and even in higher risk patients the rate of death is less than 1.0% (ASGE). Common complications include bleeding, aspiration, hematoma, and perforation. Perforation of the esophagus during dilation can cause conditions such as infection of the surrounding tissues (mediastinitis), of the lung spaces (empyema), or of the abdominal cavity (peritonitis). The conditions are serious and must be treated with hospitalization and antibiotics. Surgery sometimes is necessary to repair the perforation. Death rarely may result.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions or accommodations are not usually associated with this procedure, unless a serious underlying condition such as cancer exists.

For more information, refer to "Work Ability and Return to Work," pages 354-355.

Risk: No job meeting OSHA standards would contribute to caustic esophageal changes, progressive cancer or impact webs. GERD can be brought out by large late night meals, obesity, alcohol, caffeine, cigarettes, anti-inflammatories, pain, stress and at times chocolate, peppermint, and spearmint. Scleroderma has been associated with exposure to silica dust, vinyl chloride, and polyvinyl chloride.

Source: Medical Disability Advisor



Maximum Medical Improvement

14 days.

Source: Medical Disability Advisor



References

Cited

American Society for Gastrointestinal Endoscopy. "Esophageal Dilation." Gastrointestinal Endoscopy 48 (1998): 702-704.

Hernandez, L. V. , J. W. Jacobson, and M. S. Harris. "Comparison among the Perforation Rates of Maloney, Balloon, and Savary Dilation of Esophageal Strictures." Gastrointestinal Endoscopy 51 (2000): 460-462.

Riley, S. , and S. E. Attwood. "Guidelines on the Use of Oesophageal Dilatation in Clinical Practice." Gut 53 (2004): i1-i6.

Talmage, J. B. , J. M. Melhorn, and M. H. Hyman, eds. Work Ability and Return to Work, AMA Guides to the Evaluation of. Second ed. Chicago: AMA Press, 2011.

Source: Medical Disability Advisor






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