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.     

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.     

Gastric outlet obstruction following surgery for morbid obesity: efficacy of fluoroscopically guided balloon dilation.

PURPOSE: To evaluate the efficacy of fluoroscopically guided balloon dilation (FGBD) in patients with symptoms of gastric outlet obstruction following surgery for morbid obesity. MATERIALS AND METHODS: Forty-one FGBDs were performed in 28 patients with symptoms of gastric outlet obstruction following gastric restrictive surgery for morbid obesity. The efficacy of FGBD was determined using five end points: (a) no recurring symptoms for an interval of at least 3 months, or recurring symptoms treated either (b) surgically, (c) with endoscopically guided balloon dilation (EGBD), (d) with FGBD, or (e) medically. RESULTS: Following initial FGBD, 11 of 28 patients (39%) remained asymptomatic during at least 3 months of follow-up. Recurrent dysphagia occurred in 17 patients (60%), who were treated either surgically (n = 3), with EGBD (n = 4), with FGBD (n = 9), or medically (n = 1). Of the nine patients who underwent a second FGBD, two became asymptomatic. The seven patients who remained symptomatic were treated with surgery (n = 3), EGBD (n = 1), or FGBD (n = 3). Of the three patients treated with a third FGBD, one became asymptomatic. Overall, FGBD was effective in 14 (50%) of 28 patients. CONCLUSION: Among patients with symptoms of obstruction following gastric surgery for morbid obesity, 50% experienced relief of symptoms following FGBD.     

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.     

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.     

球囊扩张及内支架成形术治疗气管良恶性狭窄的临床应用

目的 评价X线监视下内支架成形术和球囊扩张术治疗良恶性气管狭窄的临床意义.方法 回顾分析45例气道狭窄患者,其中恶性气管狭窄37例,包括纵隔淋巴结转移14例、食管癌13例、肺癌4例、支气管腺癌3例、淋巴瘤2例、喉癌1例;良性气管狭窄8例,包括支气管内膜结核6例、胸骨后甲状腺腺瘤1例、气管插管后1例.对其中38例患者行气道内支架成形术,7例患者行球囊扩张术.所有操作均在X线透视下完成.结果 38例患者共放置53枚支架,除1例死于痰液窒息外,其他患者术后临床症状均即刻缓解,随访无支架移位;4例患者发生再狭窄,分别行再次内支架成形术和球囊扩张术.7例患者共行19次球囊扩张术,术后症状明显缓解,无复发.平均随访24.5个月(0～124个月),31例因疾病死亡,无与支架或球囊扩张相关死亡病例.结论 X线透视下行内支架成形术和球囊扩张术是治疗良恶性气管狭窄的安全、快速、有效方法.     

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。     

Palliative treatment of unresectable esophagogastric junction tumors: balloon dilation combined with chemotherapy and/or radiation therapy and metallic stent placement

PURPOSE: To prospectively evaluate an algorithm for palliative treatment of unresectable esophagogastric junction tumors based on stricture length. MATERIALS AND METHODS: Eighty-six patients with malignant esophagogastric obstructions were referred to the interventional radiology department for balloon dilation or stent placement due to dysphagia. Balloon dilation was performed in patients (n = 39) with a short segmental (< or =4 cm) stricture, whereas stent placement was performed in patients (n = 47) with a long segmental (>4 cm) stricture. In the balloon group, 16 patients with esophageal carcinoma underwent both chemotherapy and radiation therapy, whereas 23 patients with gastric carcinoma underwent only chemotherapy. RESULTS: Technical success was achieved in all procedures in all patients (100%). The overall clinical success rate of balloon dilation and stent placement for a malignant esophagogastric junction was 87% (75 of 86 patients). Clinical success was achieved in 29 of the 39 patients in the balloon group (74%) and 98% (46 of the 47 patients in the stent group (98%). The overall complication rate was 21% (18 of 86 patients). Seventeen complications, which consisted of reflux (n = 8), migration (n = 6), tumor overgrowth (n = 2), and tissue hyperplasia (n = 1), occurred after stent placement, whereas one complication (intramural rupture) occurred after balloon dilation. The median symptom-free and survival periods were 120 (95% confidence interval: 114, 263) and 147 (95% confidence interval: 98, 196) days, respectively. CONCLUSIONS: The treatment strategies seem to be reasonable for palliative therapy in patients with malignant esophagogastric junction obstructions. However, further investigations are needed to minimize the drawbacks of the methods and to determine optimal treatments in patients with unresectable malignant esophagogastric junction obstructions.     

Fluoroscopically Guided Balloon Dilation for Postintubation Tracheal Stenosis

Purpose

Little was known about the safety and long-term efficacy of fluoroscopically guided balloon dilation for postintubation tracheal stenosis. The purpose of this study was to evaluate the safety and long-term efficacy of fluoroscopically guided balloon dilation in patients with postintubation tracheal stenosis.

Methods

From February 2000 to November 2010, 14 patients underwent fluoroscopically guided balloon dilation for postintubation tracheal stenosis. Technical success, clinical success, and complications were evaluated. Patients were followed up for recurrent symptoms.

Results

In all patients, fluoroscopically guided balloon dilation was technically and clinically successful with no major complications. Following the initial procedure, six patients (43 %) remained asymptomatic during a follow-up period. Obstructive symptoms recurred in eight patients (57 %) within 6 months (mean, 1.7 months), who were treated with repeat balloon dilation (n = 4) and other therapies. Of the four patients who underwent repeat balloon dilation, three became asymptomatic. One patient became asymptomatic after a third balloon dilation. On long-term (mean, 74 months) follow-up, 71 % of patients experienced relief of symptoms following fluoroscopically guided balloon dilation.

Conclusions

Fluoroscopically guided balloon dilation may be safe, is easy to perform, and resulted in effective treatment in patients with postintubation tracheal stenosis.     

Malignant Esophagogastric Junction Obstruction: Efficacy of Balloon Dilation Combined with Chemotherapy and/or Radiation Therapy

Purpose: To assess the efficacy of balloon dilation combined with chemotherapy and/or radiation therapy for palliation of dysphagia due to malignant esophagogastric junction strictures. Methods: Fluoroscopically guided balloon dilation was attempted in 20 patients. The causes of strictures were gastric adenocarcinoma (n = 10) and esophageal squamous cell carcinoma (n = 10). Scheduled chemotherapy and/or radiation therapy followed balloon dilation in all patients. Results: There were no technical failures or major complications. After balloon dilation, 15 (75%) patients showed improvement of dysphagia. No patient complained of reflux esophagitis during the follow-up period. Among the 15 patients, seven needed no further treatment for palliation of dysphagia until their deaths. The remaining eight patients underwent repeat balloon dilation (n = 4) or stent placement (n = 4) 3–43 weeks (mean 15 weeks) after the initial balloon dilation because of recurrent dysphagia. Conclusion: Balloon dilation combined with chemotherapy and/or radiation therapy seems to be an easy and reasonably effective palliative treatment for malignant esophagogastric 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.     

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.     

Anastomotic strictures of the upper gastrointestinal tract: results of balloon dilation

Enteroenteric anastomotic strictures of the upper gastrointestinal tract are common and require treatment if significant obstruction occurs. The authors performed 44 fluoroscopically guided balloon dilations in 19 patients with symptomatic anastomotic strictures. The anastomoses were esophagoesophageal (n = 5), esophagogastric (n = 8), esophagoileocolonic (n = 4), and gastrojejunal (n = 2). Nine patients required only one balloon dilation for stricture lysis and relief of clinical symptoms. Recurrent symptoms developed in the remaining ten patients, who required two to eight dilations. Radiographically, stenoses made up 40%-90% of the anastomotic lumen before dilation (mean, 72%). Complete resolution of the stricture was achieved during the procedure in 24 instances. Residual stenosis in 18 instances varied from 7% to 45% (mean, 21%). Two complications, a mucosal tear and a perforation, were immediately recognized and successfully treated non-operatively. The authors conclude that fluoroscopically guided balloon dilation has an important role in the treatment of anastomotic strictures of the upper gastrointestinal tract.     

Placement of venous stents: clinical experience with a self-expanding prosthesis.

A self-expanding vascular prosthesis was used to treat 20 venous stenoses or occlusions in 13 patients. The lesions were caused by tumor (n = 5), postoperative fibrous scars (n = 2), and chronic hemodialysis fistulas (n = 13). Follow-up ranged between 6 weeks and 53 months (mean follow-up, 14.9 months). Acute occlusion occurred in two stents, one within a tumor stenosis and one in a dialysis shunt after 3 days and 2 days, respectively. Balloon angioplasty, thrombolysis, and aspiration in the first case and balloon angioplasty and thrombolysis in the second case successfully restored patency. Definite occlusion occurred in these two patients after 8 weeks and 5 months, respectively. Ten secondary interventions were performed in three patients with 10 restenoses who had stenotic arm veins in chronic hemodialysis at presentation. Five of seven patients who received treatment for stenoses associated with hemodialysis underwent successful kidney transplantation 5-27 months after placement of vascular stents. Both patients who received treatment for benign strictures had patent stents at follow-up examinations performed at 45 and 53 months, respectively. Four of five stents placed for malignant stenoses were patent at venography (n = 3) or autopsy (n = 1).     

Fluoroscopic Balloon Dilation Using a Flexible Guide Wire to Treat Obstructive Eustachian Tube Dysfunction

PurposeTo prospectively evaluate the midterm outcomes of fluoroscopic eustachian tube (E-tube) balloon dilation by using a flexible guide wire in patients with obstructive E-tube dysfunction.Materials and MethodsFrom October 2016 to September 2017, adult outpatients with persistent otitis media who were unable to perform the Valsalva maneuver were prospectively enrolled. The analysis included 32 E-tubes from 31 patients (18 women, 13 men; mean age, 47 years old, range 25–72 years). Participants underwent fluoroscopic E-tube balloon dilation with a 0.035-inch flexible guide wire and a 6- × 20-mm balloon catheter. Clinical examinations to check for the ability to perform the Valsalva maneuver and otomicroscopy were conducted at 1 week and then at 1, 3, 12, and 18 months after the procedure.ResultsBalloon dilation was technically successful in all E-tubes. The mean time required for the procedure was 6.9 minutes (range, 5.8–10.3 minutes). The Valsalva maneuver was successful in opening 25 of 32 E-tubes (78.1%) at 3 months after balloon dilation. During the median follow-up of 15.9 months, failure of the Valsalva maneuver occurred in 4 of 25 improved E-tubes (16%), yielding a 2-year patency rate of 84%.ConclusionsThe fluoroscopic balloon dilation results were encouraging, and using a flexible guide wire for E-tube balloon dilation did not cause a false passage.     

Tuberculous stenosis of the left main bronchus: results of treatment with balloons and metallic stents

PURPOSE: To assess the results of treatment with balloon dilation and metallic Z stents in patients with tuberculous stenosis of the left main bronchus. MATERIALS AND METHODS: Nineteen patients with tuberculous stenosis of the left main bronchus were treated with balloon (n = 15) and self-expanding metallic Z stents (n = 4). Respiratory status and pulmonary function tests were followed up for 2-90 months. RESULTS: In the balloon group, improvements in dyspnea occurred in 73% (11 of 15 patients) immediately, 73% after 1 month, 73% after 6 months, 64% after 1 year, 64% after 3 years, and 42% after 6 years (Kaplan-Meier method). Improvement of pulmonary function (FEV1 or FVC) was achieved in 62% (eight of 13) after 1 year. In the stent group, immediate improvements of dyspnea or pulmonary function occurred in all patients. However, fracture of the stents occurred in two patients, at 4 and 18 months, respectively. Occlusion of the lumen of the stent by granulation tissue occurred in another at 18 months. CONCLUSION: Balloon dilation can be an effective method for the treatment of tuberculous stenosis of the main bronchus. Metallic Z stents should be used cautiously because of their problems of mechanical durability and overgrowth of granulation tissue.     

Gallstone recurrence after cholecystolithotomy

Surgical cholecystostomy is performed often at our institution for emergent management of acute calculous cholecystitis in high-risk elderly patients. Gallstones are removed either during surgery or by subsequent radiologic manipulation. Most such patients do not undergo subsequent cholecystectomy. The frequency of gallbladder stone and/or biliary symptom recurrence was studied in 63 patients who had undergone successful cholecystolithotomy. Follow-up examinations in 48 of these patients, performed at a mean of 18 +/- 12 months after surgery, showed recurrence of gallstones in 13 patients (27%). This included 12 of 38 patients who had follow-up sonograms and one of two cadavers that underwent autopsy. None of eight patients who had a subsequent cholecystectomy had recurrent stones. Two of 17 patients studied within 1 year of cholecystolithotomy had recurrent calculi, as did six of 21 patients studied at 1-2 years, four of five patients studied at 2-3 years, and one of five patients studied at 3-4 years. Biliary symptoms were assessed in 46 of the 48 patients who had follow-up examinations (two patients died) and in the 15 other patients who had undergone successful cholecystolithotomy. Recurrent or residual symptoms were present in seven (11%) of 61 patients, including three of the 13 patients with recurrent calculi. Six of these seven patients underwent further hospital treatment. These results confirm the anticipated high frequency of stone recurrence after cholecystolithotomy. However, because most patients with recurrent stones were asymptomatic, routine interval cholecystectomy may not be necessary.     

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.     

Endovascular treatment of hepatic venous outflow obstruction after living-donor liver transplantation

PURPOSE: To evaluate the effectiveness and safety of percutaneous interventional management of hepatic venous outflow obstruction after living-donor liver transplantation (LDLT). MATERIALS AND METHODS: Percutaneous balloon angioplasty (n = 5) and stent placement (n = 22) were attempted in 27 patients with hepatic venous outflow obstruction. Patient follow-up included clinical and laboratory data collection, Doppler ultrasonography (US), hepatic venography, and computed tomography. The following parameters were documented retrospectively: technical success and complications, clinical improvement, and recurrence. Technical success was defined as elimination or successful reduction of pressure gradients across the stenosis and clinical success was defined as amelioration of presenting signs. Recurrence was defined as relapse of clinical signs with hepatic venous anastomotic restenosis on Doppler US. RESULTS: Technical success was achieved in all patients. The mean pressure gradients across the stenoses before and after the procedure were 10.6 mm Hg +/- 6.4 (range, 3-39 mm Hg) and 2.4 mm Hg +/- 2.6 (range, 0-8 mm Hg), respectively (P < .001). Three of the five patients who underwent balloon angioplasty developed recurrent stenosis 1-5 weeks after the procedure. These patients underwent repeat balloon angioplasty, and two of them eventually underwent stent placement (n = 1) or surgical repositioning (n = 1) of the graft. Three of the 22 patients who underwent stent placement required a second stent placement procedure because of malpositioning, partial migration, and acute angulation. During the mean follow-up period of 49 weeks +/- 47 (range, 3-214 wk), clinical success was achieved in 20 of 27 patients (73%). CONCLUSION: Percutaneous interventional management is an effective and safe adjunct for the treatment of hepatic venous outflow obstruction after LDLT.     

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.