Gastric outlet obstruction caused by benign anastomotic stricture: treatment by fluoroscopically guided balloon dilation

PURPOSE: To evaluate the clinical efficacy and safety of fluoroscopically guided balloon dilation of gastric outlet obstruction caused by benign anastomotic stricture. MATERIALS AND METHODS: Fluoroscopically guided balloon dilation was performed on 17 patients with gastric outlet obstruction caused by benign anastomotic stricture. Fourteen patients underwent surgery for malignant disease and three patients for complication of benign gastric ulcer. The sites of anastomotic stricture were gastrojejunal (n = 12) or gastroduodenal (n = 5). An upper gastrointestinal (UGI) series was performed just following and 1 month after balloon dilation to evaluate both the clinical success of the procedure and any complications. A dietary intake was evaluated by using the score for patients with malignant dysphagia and the pre- and postballoon dilation scores were analyzed with the Wilcoxon signed rank test. RESULTS: In all patients, fluoroscopically guided balloon dilation was performed in one (n = 15) or two (n = 2) sessions and was technically and clinically successful (100%). The diameters of the balloon catheters used were 15 mm (n = 4), 20 mm (n = 14), and 25 mm (n = 1 mm; mean, 19.5 mm) in a total of 19 sessions. All patients had significant improvement of their levels of dietary intake (P < .001). Two of the 17 patients required the second procedure due to recurrent symptom nine and 15 months, respectively, after initial balloon dilation. Overall, 16 patients (94%) showed good results and no recurrence during a mean follow-up period of 13.5 months (range, 5-39 months). There were no major complications associated with balloon dilation. CONCLUSION: Fluoroscopically guided balloon dilation seems to be effective and safe for patients with gastric outlet obstruction caused by benign anastomotic stricture. Achieving a luminal diameter of 20 mm seems to be necessary to prevent recurrence of symptoms.     

Colorectal anastomotic strictures: treatment by fluoroscopic double balloon dilation

PURPOSE: To evaluate the therapeutic efficacy and complications of fluoroscopically guided double balloon dilation for treatment of colorectal anastomotic strictures. MATERIALS AND METHODS: Under fluoroscopic guidance, 17 patients with colorectal anastomotic strictures underwent transanal double balloon dilation. Thirteen of 17 strictures were the consequence of surgery for malignant disease and the other four were secondary to surgery for benign disease. Sixteen of 17 patients had difficult or frequent defecation caused by partial obstruction. In the remaining one asymptomatic patient, the stricture was detected by endoscopy and barium enema after total proctocolectomy and a temporary ileostomy for ulcerative colitis. The therapeutic efficacy and complications were evaluated during the follow-up. RESULTS: Seventeen patients underwent double balloon dilation in a single session. The diameter of the first balloon was 20 mm and the second balloon's diameter was 10, 15, or 20 mm. Technical success was achieved in all 17 patients. After balloon dilation, complete (n = 12, 71%) or incomplete (n = 5, 29%) improvement of symptoms was achieved in all patients. Major complications such as perforation or severe hemorrhage did not occur. During the mean follow-up period of 23 months (range, 1-62 months), one patient (6%) developed a recurrent stricture and required a second session of double balloon dilation 6 months after initial balloon dilation. CONCLUSION: Fluoroscopically guided double balloon dilation is an effective and safe method for the treatment of colorectal anastomotic strictures.     

Fluoroscopically guided balloon dilation for benign anastomotic stricture after Ivor-Lewis esophagectomy: experience in 62 patients

PURPOSE: To evaluate the safety and clinical effectiveness of fluoroscopically guided balloon dilation in 62 patients with benign anastomotic stricture after Ivor-Lewis esophagectomy. MATERIALS AND METHODS: Between January 1996 and June 2004, fluoroscopically guided balloon dilation was undertaken in 62 patients with benign anastomotic stricture after Ivor-Lewis esophagectomy. Radiologic images and medical records including complications were retrospectively reviewed. The maximum diameters of the balloon catheters used were 18-20 mm. Clinical success was defined by the absence of recurrent dysphagia after balloon dilation until the most recent follow-up. The Fisher exact test was used to assess the relationship of symptomatic recurrence and the balloon size, width of the stricture, and radiation therapy. RESULTS: There were 115 sessions of balloon dilation in 62 patients (mean, 1.85 sessions per patient). Clinical success was achieved in 59 patients (95%) by means of a single dilation (n = 29) or by multiple dilations (n = 30). One patient with severe stenosis was successfully treated with temporary placement of a covered retrievable stent. Major complications such as esophageal perforation or massive bleeding did not occur. Four patients with mucosal tear (n = 3) or aspiration pneumonia (n = 1) were conservatively treated. Patients with severe stricture had more symptomatic recurrences than those with moderate stricture. CONCLUSION: Fluoroscopically guided balloon dilation is a safe and successful treatment modality for benign anastomotic stricture after Ivor-Lewis esophagectomy.     

双球囊导管成形术治疗结直肠吻合口良性狭窄

目的评价透视下双球囊导管成形术治疗结直肠吻合口良性狭窄的疗效。方法17例结直肠吻合口良性狭窄的患者,在透视下行经肛门双球囊导管成形术。13例因恶性、4例因良性病变而接受结、直肠外科手术。16例因部分性梗阻表现为排便困难或排便次数增多,1例患者因溃疡性结肠炎,作全结肠切除术 临时性肠造瘘术后,其吻合口狭窄由内镜和钡灌肠检查发现并确定为良性。随访期观察疗效和并发症。结果17例患者在透视下进行了双球囊导管成形术1次。双球囊扩张成形术中,先用单球囊(直径为20mm)作为初步扩张,再附加第2枚球囊(直径为10、15或20mm)进行双球囊导管成形术。技术成功率为100%。球囊导管成形术后,症状完全改善12例(71%)、部分改善5例(29%)。未发生如肠破裂或严重出血等并发症。平均随访23个月(1～62个月),1例6个月后狭窄复发,给予再次双球囊导管成形术后,狭窄症状消失。结论透视下双球囊导管成形治疗良性结直肠吻合口狭窄安全可行。     

Early symptomatic strictures after gastric surgery: palliation with balloon dilation and stent placement

PURPOSE: To evaluate the clinical efficacy and safety of balloon dilation and stent placement in the treatment of early benign anastomotic strictures after gastric surgery. MATERIALS AND METHODS: From 1997 to 2006, 63 patients with early (< or =3 months) benign anastomotic strictures after gastric surgery underwent fluoroscopic balloon dilation or stent placement due to obstructive symptoms. In all patients, balloon dilation was initially performed. Stent placement was indicated in patients who showed poor response to repeat balloon dilation. RESULTS: Balloon dilations were successfully performed in all 63 patients, with only three intramural tears. Thirty-one of the 63 patients (49%) showed good response to initial balloon dilation and required no further treatment until the end of follow-up or death. Conversely, 32 patients (51%) had poor or no response or recurrence after initial balloon dilation and required multiple balloon dilations (n = 20), stent placement (n = 7), percutaneous gastrojejunostomy (n = 2), and/or surgical revision (n = 3). At multivariate analysis, the anastomotic site was the only independent factor predictive of the response to balloon therapy (P < .001). During a mean follow-up of 12 months, overall clinical success was achieved in 56 of the 63 patients (89%) after a single balloon dilation (n = 31), multiple balloon dilations (n = 20), and stent placement (n = 5). CONCLUSIONS: Balloon dilation is safe and effective for the treatment of patients with early benign anastomotic strictures after gastric surgery. Stent placement can be effective in selected patients with early benign anastomotic strictures refractory to balloon dilation.     

Fluoroscopically guided balloon dilation for benign anastomotic stricture in the upper gastrointestinal tract

A benign anastomotic stricture is a common complication of upper gastrointestinal (UGI) surgery and is difficult to manage conservatively. Fluoroscopically guided balloon dilation has a number of advantages and is a safe and effective procedure for the treatment of various benign anastomotic strictures in the UGI tract.     

Fluoroscopically guided balloon dilation for patients with esophageal stricture after radiation treatment

PURPOSE: To evaluate the safety and clinical effectiveness of fluoroscopically guided balloon dilation in patients with esophageal stricture after radiation therapy (RT). MATERIALS AND METHODS: From April 1993 through December 2004, fluoroscopically guided balloon dilation was performed in 15 patients with esophageal strictures secondary to previous RT. Technical success, clinical success, recurrence of dysphagia, primary and secondary patency rates, and complications related to the procedure were retrospectively evaluated. RESULTS: Twenty-five balloon dilations were performed in 15 patients, with a mean of 1.7 dilations per patient (range, 1-5). Technical success was achieved in all procedures. One patient was immediately lost to follow-up and another underwent elective esophageal surgery 13 days after the procedure. Of the remaining 13 patients, clinical success was achieved 11 (85%). Two of 13 patients exhibited recurrence of dysphagia before 1 month after balloon dilation. Among the 11 patients in whom clinical success was achieved, seven exhibited maintained initial improvement of dysphagia until their last follow-up (mean, 174 days) and four exhibited recurrence of dysphagia after the first balloon dilation. Dysphagia recurred 2-128 days (mean, 67.2 d) after the first balloon dilation in six of the 13 patients (46%), who underwent further balloon dilation and/or stent placement. The primary and secondary patency rates at 1, 3, and 6 months were 86%, 68%, and 47% and 100%, 92%, and 62%, respectively. There were no major complications. Type 1 and 2 esophageal ruptures occurred after 12 dilations in nine patients; they were treated conservatively. CONCLUSION: Fluoroscopically guided balloon dilation for esophageal stricture after RT can be safe and effective. However, the high rate of recurrent dysphagia requires repeated dilations.     

Rectal strictures: treatment with fluoroscopically guided balloon dilation

The authors performed 25 fluoroscopically guided balloon dilation procedures in nine patients with rectal strictures. In all cases, the stricture developed after rectal surgery. Four patients underwent ileoanal anastomosis after total colectomy for various conditions; five patients underwent rectosigmoid end-to-end anastomosis after resection of a tumor or as treatment for diverticulitis. Maximal stricture dilatation was attained in 20 instances with a single 15-30-mm balloon. In five procedures, two balloons (20 or 15 mm) were inflated simultaneously ("kissing balloons" technique) to dilate the strictures. In five patients, only one dilation procedure was required for effective treatment of the strictures, with no clinical evidence of strictures after follow-up of 1.5-56 months (mean, 29.5 months). In the other four patients, multiple procedures were performed: nine in one patient, five in one patient, and three in two patients. In these patients, no recurrent symptoms developed during follow-up of 1.25-18 months (mean, 8.1 months) after the last dilation. Complicating leaks, infection, or hemorrhage did not occur after any of the procedures. Fluoroscopically guided balloon dilation is a safe and effective procedure for the treatment of rectal strictures.     

Fluoroscopically guided balloon dilation of anastomotic strictures after total gastrectomy: long-term results

OBJECTIVE: The purpose of this study was to evaluate the radiologic and clinical effectiveness and long-term results of fluoroscopically guided balloon dilation of anastomotic strictures after total gastrectomy. CONCLUSION: Fluoroscopically guided balloon dilation is effective and safe and has encouraging long-term results in the management of benign anastomotic strictures after total gastrectomy.     

Balloon catheter dilation of ureteroenteric strictures: long-term results

Balloon catheter dilation of benign ureteroenteric anastomotic strictures has been proposed as an alternative to either surgical revision or chronic ureteral stenting, with moderately successful short-term results reported by several groups in a limited number of patients. However, the authors' experience with 29 patients exhibiting 37 benign ureteroenteric strictures treated over the past 7 years revealed that in the majority of cases (23 patients, 26 strictures [70%]), strictures recurred within 6 months of balloon catheter dilation/ureteral stent therapy. Furthermore, of the 11 strictures that appeared to have been successfully dilated at a follow-up interval of 6 months, five restenosed within 1 year. Therefore, only six of 37 (16%) ureteroenteric stricture dilations could be considered successful when viewed at least 1 year after interventional therapy. Furthermore, repeat dilations have often been required to maintain ureteral patency in these patients.     

透视下球囊扩张术治疗婴幼儿食管良性狭窄的临床疗效分析

目的：探讨透视下球囊扩张术治疗婴幼儿食管良性狭窄的临床疗效及安全性。 方法：回顾性分析我院2007年7月至2015年12月收治的53例食管良性狭窄患儿（其中食管腐蚀性狭窄组14例,食管闭锁术后吻合口狭窄组39例）的临床资料,所有患儿经X线钡餐造影确诊后,在影像引导下进行食管狭窄的球囊扩张治疗,比较两组术中的扩张效果。术后随访6~18个月,观察并比较两组疗效。 结果：53例患儿共进行187次球囊扩张术,平均每个患儿扩张3.5次（范围1~11次）,球囊直径范围为6~20 mm。食管腐蚀性狭窄组患儿均需经过两次及以上扩张,扩张成功14例（100%）。食管吻合口狭窄组患儿中,1次扩张成功11例（28.2%）,两次及以上扩张成功28例（71.8%）。两组的扩张次数差异无统计学意义（P>0.05）。术后行X线钡餐造影示食道狭窄段较前显著扩张,造影剂通过顺利,达到治愈标准,扩张成功率为100%。所有患儿术后随访6~18个月,总有效率（79.2%,42/53）,吻合口狭窄组患儿FBD治疗有效率（87.1%,34/39）高于腐蚀性狭窄组（57.1%,8/14）,差异有统计学意义（χ²=3.972,P<0.05）。 结论：透视下球囊扩张术治疗婴幼儿食管良性狭窄临床疗效显著,特别对于食管闭锁术后吻合口狭窄的患儿,安全性好,且易操作,临床应用和推广价值高。     

带囊导管扩张术治疗上胃肠道狭窄经验总结：附164例疗效分析

One hundred and sixty-four cases of upper gastrointestinal strictures were treated with balloon dilatation in a period of 4 years. Totally 682 procedures were performed. Among them, sequential treatment and follow-up studies were done in 140 cases including anastomotic stricture 95, corrosive stricture of esophagus 33 and other kinds of stenosis of esophagus 12. The total effective rate was 90% (126/140) and long term effective rate 71.4% (100/140). Failure was observed in 14 cases (10%), of which 11 cases were due to tumor recurrence. In this paper the authors proposed the concept about short-term and long-term effect and criteria for evaluation; The factors influencing the effectiveness and the number of procedure undertaken are related to the cause and degree of stricture as well as the time selected for dilatation. The indications for such dilatation treatment are anastomotic stricture of upper gastrointestinal tract, esophageal web and corrosive stricture of esophagus. This method could be used as the treatment of choice, for cicatrical stricture of upper gastrointestinal tract of various causes.     

Rhenium-188 mercaptoacetyltriglycine-filled balloon dilation in the treatment of recurrent urethral strictures: initial experience with five patients

PURPOSE: To evaluate the efficacy of beta-irradiation therapy with use of a rhenium-188 mercaptoacetyltriglycine ((188)Re-MAG(3))-filled balloon for the prevention of restenosis in urethral strictures refractory to repetitive surgical or interventional procedures. MATERIALS AND METHODS: Five male patients with traumatic (n = 4) or postoperative anastomotic (n = 1) recurrent urethral strictures were included. One to four sessions of 20-30 Gy beta-irradiation at a 1-mm tissue depth with (188)Re-MAG(3)-filled balloon dilation were undertaken in each patient. RESULTS: No procedural complications or toxicities were noted. During the mean follow-up period of 16.2 months, the stricture did not recur in two patients, whereas three patients required additional interventional procedures. In two of these patients, the treatment intervals between the required sessions were significantly prolonged. For the entire group, the mean treatment interval was prolonged from 2.2 months before (188)Re-MAG(3)-filled balloon dilation to 10.7 months after therapy. CONCLUSION: (188)Re-MAG(3)-filled balloon dilation shows promise in preventing or delaying stricture recurrence in patients with recurrent urethral strictures.     

婴儿食管吻合口狭窄球囊扩张术

目的：本文报告４例婴儿食管吻合口狭窄使用球囊扩张术治疗。材料和方法：４例女婴均为食物闭锁术后２￣１５个月出现吻合口狭窄，狭窄内径３￣６ｍｍ。采用球囊导管分次扩张，球囊直径６￣１５ｍｍ。结果：４例共进行球囊扩张１２次，保持临床无症状期４￣６个月。无食管穿孔并发症。结论：球囊扩张术简单、安全、有效，为婴儿食物吻合口狭窄的首选治疗方法。     

Corrosive esophageal stricture: safety and effectiveness of balloon dilation.

The safety and long-term effectiveness of fluoroscopically guided balloon dilation for corrosive esophageal stricture was evaluated in 22 patients with a follow-up period of more than 1 year (range, 13-52 months). The average interval between corrosive agent ingestion and initial balloon dilation was 18 years (range, 2 months to 51 years). Balloons with a diameter of 5-8 mm were used in the initial attempt. The caliber of the balloon catheter was increased gradually over subsequent dilations, up to a diameter that allowed patients to swallow solid foods. Dilation of more than 17 mm in diameter was performed in five patients. Patients underwent one to five sessions. Esophageal rupture occurred in seven patients and was treated nonoperatively in five and surgically in two. With exclusion of these latter two, 11 of 20 could tolerate swallowing all kinds of food and nine could tolerate swallowing most foods. Balloon dilation in corrosive esophageal strictures is effective, but the high rupture rate indicates the need for extra caution.     

Radiologically guided balloon dilation of gastrointestinal strictures. Part I. Technique and factors influencing procedural success

Radiologically guided balloon catheters were used to dilate 94 gastrointestinal strictures in 92 patients over a 6-year period. Fifty strictures were esophageal and 44 nonesophageal (22 gastroenterostomies, 11 antral-pyloric strictures, four colorectal strictures, four enteroenterostomies, and three miscellaneous strictures). Factors influencing the success of stricture intubation included patient age, stricture location (esophageal vs. nonesophageal and proximal vs. distal esophageal), and association with a surgical anastomosis. Malignancy was associated with greater postdilation irregularity and a smaller increase in stricture diameter, as measured radiographically. Procedural failures occurred in 8% of cases (2% of esophageal and 30% of nonesophageal lesions). Two small, asymptomatic mucosal tears were seen after dilation (one esophageal and one colonic); no other procedural complications occurred. Following successful dilation, 16 patients (17%; six with esophageal and ten with non-esophageal strictures) had recurrence of symptoms during short-term (30-day) follow-up.     

Results of temporary placement of covered retrievable expandable nitinol stents for tuberculous bronchial strictures

Covered retrievable expandable nitinol stents were successfully placed in nine patients with tuberculous bronchial strictures refractory to balloon dilation. Complications included stent migration (n = 1) and tissue hyperplasia at the proximal portion of the stent (n = 2). During the follow-up period (5-52 months), stricture recurred in three of five patients (60%) after temporary stent placement for 2 months, whereas stricture did not recur in the other four patients after temporary stent placement for 6 months. Temporary placement of covered retrievable stents appears to be an effective method for the treatment of patients with tuberculous bronchial strictures refractory to balloon dilation.     

Use of a newly designed multifunctional coil catheter for stent placement in the upper gastrointestinal tract

PURPOSE: To evaluate the usefulness of a newly designed multifunctional coil catheter for stent placement in patients with upper gastrointestinal tract strictures. MATERIALS AND METHODS: Constructed in our research laboratory, the coil catheter was used in 202 consecutive patients with malignant (n = 191) or corrosive (n = 11) upper gastrointestinal tract strictures. The coil catheter was made of a stainless-steel coil (1.3-mm inner diameter, 1.8-mm outer diameter), a 0.4-mm nitinol wire, a polyolefin tube, and a hemostasis valve. Usefulness of the coil catheter was evaluated based on whether the coil catheter could pass the stricture over a guide wire and whether measurement of the stricture length was possible while the guide wire was in place. RESULTS: The passage of the coil catheter over a guide wire beyond the stricture was technically successful and well tolerated in 199 of 202 patients (99%). Negotiation of a guide wire or a coil catheter through the stricture of the stomach (n = 2) or duodenum (n = 1) under fluoroscopic guidance failed in three patients. In two of these three patients, it was possible to negotiate a guide wire and a coil catheter under combined endoscopic and fluoroscopic guidance; it was not possible in the third. There were no procedure-related complications. CONCLUSION: The newly designed multifunctional coil catheter is useful in stent placement in patients with upper gastrointestinal tract strictures.     

Benign postoperative biliary strictures: dilation with fluoroscopic guidance

Benign postoperative biliary strictures in 74 patients were dilated percutaneously with balloon catheters. In all cases, dilation was performed with fluoroscopic guidance in a radiology suite. Lasting patency following removal of biliary stents occurred in 73% of 49 patients with biliary-enteric anastomotic strictures and in 88% of 25 patients with primary ductal strictures, for an overall success rate of 78%. A successful outcome was more likely if the interval between the last biliary tract surgery and balloon dilation exceeded 2 years. Stricture patency was more easily achieved in patients with primary ductal strictures than in those with biliary-enteric anastomotic strictures. Serious, procedure-related complications were encountered when strictures were dilated transhepatically; these included sepsis in 18 of 65 patients and bleeding due to arteriobiliary communications in seven. No serious complications occurred when strictures were dilated via a T tube track, making this the preferred route if available. Surgeons should be encouraged to leave T tubes in place if postoperative biliary stricture is suspected. Balloon dilation should be strongly considered in patients with benign postoperative strictures in whom surgical repair is difficult.     

Balloon catheter dilatation of benign esophageal strictures in children

PURPOSE: This retrospective study evaluated the safety and efficacy of fluoroscopically guided balloon dilatation of benign pediatric esophageal strictures. MATERIALS AND METHODS: Between 2000 and 2005, 272 esophageal balloon dilatations were performed in 49 children, aged 18 days to 18 years. Chart and primary physician record reviews were used to assess complications, age-appropriate food intake, and dysphagia. Efficacy was calculated by time to recurrent symptoms requiring repeat balloon dilatation. Durability was assessed by the frequency of dilatations. RESULTS: Seventy-seven percent of patients required a second dilatation within 9 months. Survival analysis (Kaplan-Meier) demonstrated no significant difference for efficacy in relation to patient age (P = .76) or stricture cause (P = .56). A decrease in the number of dilatations occurred over time to achieve longer symptom-free intervals. Patients underwent an average of 5.6 dilatations with an average total intervention time of 2 years. Patients were able to remain symptom free for a mean of 110 days. The procedure had a success rate of 100%, the only major complication being an esophageal perforation (complication rate, 0.37%) in a patient with a stricture secondary to correction of a tracheoesophageal fistula. CONCLUSIONS: Balloon esophageal dilatation in children is an effective and safe first-line therapy. Complications are quite rare and manageable. Although cures are unusual, most children require less than one dilatation every 6 months. It is concluded that fluoroscopically guided balloon dilatation should be the primary method of treating benign esophageal strictures.