Successful treatment of congenital esophageal web by endoscopic electrocauterization and balloon dilatation

We report a 3-year-old boy who presented with a foreign body impacted in the esophagus and had a poor tolerance of solid food since he was 5 to 6 months old. In the last 2 years, he developed progressive dysphagia, anorexia, vomiting, and poor weight gain. An esophagoscopy and barium esophagogram revealed an esophageal web in the distal third of the esophagus. Three courses of endoscopic balloon dilatation resulted in transient improvement in his dysphagia and vomiting; a follow-up barium esophagogram and esophagoscopy showed limited improvement of the esophageal stenosis. Two courses of endoscopic electrocauterization and balloon dilatation improved the clinical symptoms and esophageal stenosis.     

Endoscopic balloon dilatation of colonic anastomotic strictures

Nine postoperative colonic and rectal strictures were treated using dilatation balloons passed over a guide-wire introduced endoscopically. Six strictures resolved after a single dilatation. The method is simple, safe, effective and avoids further surgery.     

Endoscopic balloon dilatation without fluoroscopy for treating gastric outlet obstruction because of benign etiologies

Background  

Benign gastric outlet obstruction (GOO) causes considerable morbidity and conventional treatment has been surgery. Endoscopic balloon dilatation is a minimally invasive treatment modality for GOO but experience with its use is mainly in patients with GOO due to peptic ulcer disease. We report our experience of endoscopic balloon dilatation in benign GOO of various etiologies.     

Comparison between Savary-Gilliard and balloon dilatation of benign esophageal strictures

The efficiency and safety of the 2 most commonly used endoscopic dilators, Savary-Gilliard and pressure balloons, were compared in 2 groups, each including 30 patients, with benign esophageal strictures. Four additional patients with tight and tortuous cervical esophageal strictures were initially managed by balloon dilatation followed by Savary-Gilliard dilatation. These patients could not be dilated by each of the methods alone. Sixty patients [35 males and 25 females with a mean age of 52 years (range, 4–91)] underwent 165 esophageal dilatations. The etiologies of strictures included reflux esophagitis (65%), caustic damage (18.3%), and postoperative (anastomotic, or post-Nissen operation) in 16.7%. Dysphagia improved in all patients; however, 2 patients (1 from each group) with hard postoperative anastomotic stricture eventually underwent surgical resection of stricture. There were no major complications or mortality related to the dilatations. Both methods were highly effective and well tolerated, yet Savary-Gilliard dilators were slightly more effective and simpler to use than balloons. Nevertheless, tortuous cervical strictures and multiple closely-placed strictures were more effectively managed by initial use of balloon followed by Savary dilators.

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Resumen Se efectuó la comparación de la seguridad y la eficacia de los 2 dilatadores endoscópicos más utilizados, el dilatador de Savary-Gilliard y el balón de presión, en 2 grupos, cada uno de 30 pacientes con estenosis benignas del esófago. Cuatro pacientes adicionales con estenosis severas y tortuosas del esófago cervical fueron manejados inicialmente con dilataciones con balón seguidas de dilataciones con el dilatador de Savary-Gilliard. Estos pacientes no pudieron ser dilatado mediante uno sólo de los 2 métodos. Sesenta pacientes [35 hombres y 25 mujeres, con edad promedio de 52 años (rango de 4 a 91)], recibieron 165 dilataciones esofágicas. Las etiologías de las estenosis incluyeron la esofagitis de reflujo (65%), la lesión cáustica (18.3%), y la estenosis postoperatoria (anastomótica o postoperación de Nissen) en 16.7%. La disfagia mejoró en la totalidad de los pacientes. Sin embargo, 2 casos (1 en cada grupo) con estenosis anastomótica fibrótica eventualmente fueron sometidos a resección quirúrgica de la estenosis. No se presentaron complicaciones mayores ni mortalidad relacionada con las dilataciones. Ambos métodos probaron ser altamente efectivos y bien tolerados, aunque los dilatadores de Savary-Gilliard aparecieron ligeramente más efectivos y más fáciles de usar que los balones. Sin embargo, las estenosis tortuosas del esófago cervical así como las estenosis múltiples y cercanas unas de otras, pudieron ser más efectivamente manejadas mediante el uso inicial de balones, seguido de dilatadores de Savary.

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Résumé On a comparé l'efficacité et l'inocuité des 2 dilatateurs endoscopiques le plus souvent utilisés, bougies de Savary-Gilliard et sondes à ballonnets, chez 2 groupes comprenant chacun 30 patients ayant une sténose oesophagienne bénigne. On a traité également 4 patients ayant une sténose oesophagienne cervicale sinueuse et serrée d'abord par dilatation avec ballonnets puis par dilatation avec des bougies de Savary-Gilliard. Ces patients n'ont pu être dilatés par une seule des 2 méthodes. Soixante patients [35 hommes et 25 femmes, âgés en moyenne de 52 ans (ages extrèmes de 4 à 91)] ont eu une dilatation oesophagienne par une seule méthode. Les étiologies de la sténose étaient les suivantes: oesophagite peptique (65% des cas), lésion caustique (18.3%), ou postopératoire (anastomotique, ou suivant une opération de Nissen) (16.7%). Chez tous les patients la dysphagie s'est améliorée. Toutefois, 2 patients (1 de chaque groupe) ayant une sténose anastomotique postopératoire serrée ont eu par la suite une résection chirurgicale de leur sténose. Il n'y a eu ni complications graves ni mortalité imputables aux dilatations. Les 2 méthodes se sont avérées très efficaces et bien tolérées, encore que les dilatateurs Savary-Gilliard soient légèrement plus efficaces et plus faciles à utiliser que les sondes à ballonnet. Néanmoins, les sténoses cervicales sinueuses et les sténoses multiples proches les unes des autres, ont été traitées au mieux par l'emploi d'abord des ballonnets puis des dilatateurs de Savary.

     

Endoscopy-guided balloon dilatation of esophageal strictures and anastomotic strictures after esophageal replacement in children

This study evaluates the safety, efficacy, and technical problems of the new technique of endoscopy-guided balloon dilation (EGBD) in the treatment of strictures of the esophagus and its replacement. Between 1986 and 1990, the authors treated 33 children (aged 3 weeks to 20 years) with EGBD; 18 had esophageal strictures (primary esophageal atresia repair, 13; reflux esophagitis, 5), 13 had anastomotic strictures after esophageal replacement (colon, 12; stomach, 1), and 2 had caustic strictures. The majority (23 of 33) had previously failed to respond to conventional bouginage (mean, 11.2 sessions; range, 1 to 32 sessions). EGBD was performed using flexible endoscopy and flouroscopic screening under general anesthesia. Endoscopy identified and resolved the errors or uncertainties of preoperative contrast studies in 7 patients, 5 of whom had colon interposition. EGBD was achieved in all 31 patients with esophageal or replacement strictures; the mean number of EGDB procedures per patient was 2.1 (range 1 to 7). Symptomatic relief was excellent in 24 and moderate in 7 patients. Both patients with caustic strictures had esophageal perforation from EGBD (excessive inflation, 1; false passage of guide wire, 1). Patients who had experienced both conventional bouginage and EGBD noticed less pain with EGBD and resumed eating sooner. The authors conclude that EGBD is safe and effective for treating esophageal and replacement strictures but not caustic strictures.     

Endoscopic laser stricturotomy and balloon dilatation for benign colorectal strictures

Background : A fibrous stricture may develop at the site of a colorectal anastomosis or as a complication following abdominal aortic surgery. A major resection may be necessary if the stricture cannot be released. The authors’ experience with endoscopic stricturotomy using neodymium:yttrium–aluminium–garnet laser, together with balloon dilatation, as a conservative method of treating such strictures, is reported here. Methods : The case notes of all patients referred for laser treatment of benign distal large bowel strictures at Concord Hospital were reviewed. Results : Ten patients had endoscopic laser treatment combined with endoscopic balloon dilatation between October 1991 and July 1999. An anastomotic stricture had developed in eight patients and two patients had a fibrous stricture of the upper rectum after abdominal aortic aneurysm surgery. Nine of the 10 patients had their stricture treated successfully without complication or recurrence (median follow up 82 months; range: 14–104 months). The remaining patient re‐presented with a large bowel obstruction at the site of his stricture 6 years following initial treatment. Conclusion : A protocol combining laser stricturotomy with balloon dilatation appears to be a safe and effective treatment of such strictures.     

球囊扩张法在腔镜甲状腺手术中的应用

目的:探讨球囊扩张法建立人工间隙及气体微循环排出非透明气体在经胸乳入路腔镜甲状腺手术中的应用价值。方法:回顾分析2015年4月至2015年6月23例胸乳入路腔镜甲状腺手术的临床资料,术中应用球囊扩张法建立人工间隙及气体微循环排出非透明气体。结果:23例手术均获成功,无一例中转开放。建立人工间隙时间15~29 min,平均(18.0±3.5)min;手术时间65~127 min,平均(84±19)min;术中出血量15~79 ml,平均(37.0±4.5)ml;引流管留置时间24~48 h,引流液为血清样,引流量31~95 ml,平均(57.0±11.3)ml;术后住院4~8 d,平均(6.0±1.2)d。2例发生声音嘶哑,分别于半个月及1个月后恢复。3例有胸前皮肤紧缩感。2例发生胸前皮下积液,对症治疗后恢复。结论:球囊扩张法在经胸乳入路腔镜甲状腺手术人工间隙制作中创伤小,方法简单,容易复制。气体微循环能迅速排出非透明气体,节省了大量非手术时间。     

Retrograde endoscopic dilatation for difficult caustic esophageal strictures: Feasibility and effectiveness

BackgroundDifficult caustic esophageal strictures may need a more sophisticated dilatation technique before referring for esophageal replacement surgery.Patients & methodRetrospective review of caustic esophageal strictures managed at our center between January 2010 and June 2018 was done. Twenty two patients labeled as undilatable strictures were enrolled. These patients had another trial for endoscopic dilatation using retrograde approach.ResultsAmong these 22 patients, 5 patients could be dilated by antegrade approach. Seventeen patients had a trial of retrograde dilatation after failed antegrade endoscopy. Retrograde dilatation was successful in 14 patients (82%). Nasogastric tube was left following dilatation in 4 patients to facilitate next sessions. Collectively, 19 out of the 22 patients could have their esophagus dilated in the first instance (86%). Among retrograde dilated patients; eight patients succeeded to retain their native esophagus (57%), two patients are still on dilatation with marked improvement (14%), and three patients underwent colon interposition owing to refractory stricture despite frequent dilatations.ConclusionEvery attempt should be tried to preserve the native esophagus. Retrograde endoscopic dilatation is a valuable alternative for undilatable stricture before referring the patient for replacement surgery.Level of evidenceThis is a case series with no comparison group (level IV).     

Evaluation of percutaneous transhepatic balloon dilatation of benign biliary strictures in high-risk patients

During the period from 1979 through 1984, 17 patients with benign biliary strictures underwent percutaneous transhepatic balloon dilatation. All patients presented with either hyperbilirubinemia and acute cholangitis, a history of intermittent chills and fever, or both. Balloon dilatation was most successful in those patients with intrahepatic strictures, sclerosing cholangitis, strictured biliary enteric anastomoses, and distal common bile duct strictures with retained calculi. Two patients with postsurgical common bile duct injury had treatment failure 3 and 18 months after dilatation and subsequently underwent elective hepaticojejunostomy. Although our longest treatment success is now more than 4 1/2 years in an 83 year old woman who is 15 years posthepaticojejunostomy, the mean follow-up of the entire group has only been 2 years. On the basis of our early experience and that of others, we now recommend an initial attempt at balloon dilatation in most patients with postsurgical benign biliary strictures. Further technical advances and longer follow-up in present and future series may certainly broaden the appeal of this nonoperative procedure.     

Successful management of esophageal strictures without resection or replacement

Esophageal resection or replacement has become the standard therapy for severe esophageal strictures chiefly because less aggressive methods generally have failed. We hereby report our experience with 12 consecutive infants and children who have been managed successfully by means of Stamm gastrostomy and string-guided esophageal dilatation, coupled with endoscopically guided four-quadrant intralesional steroid injection, protected by Nissen fundoplication when gastroesophageal reflux has been demonstrated. In six patients, the stricture(s) were caused by ingestion of lye. In five, they were associated with repair of esophageal atresia. In one, the etiology was never determined. The strictures averaged 3.5 cm in length (range, 1 to 10 cm); the severity of the lesions was indicated by the fact that, in all instances, patients were completely intolerant of solids, and was confirmed fluoroscopically by demonstration of significant luminal narrowing. A mean of 4.3 steroid injections (range, 1 to 8) was required to obtain complete remission of symptoms; there have been no complications except in one lye ingestion patient who developed a tiny perforation following the initial dilatation, which responded to antibiotics alone. All patients remain symptom-free; the mean length of follow-up is 6.2 years (range, 1 to 11 years). We conclude that string-guided esophageal dilatation, when coupled with endoscopically guided steroid injection, is a safe and reliable method for treatment of severe esophageal strictures, which should obviate the need for esophageal resection or replacement in most patients. Moreover, even if treatment should ultimately fail, a procedure of lesser magnitude than esophageal replacement will likely be possible.(ABSTRACT TRUNCATED AT 250 WORDS)     

Outcome of endoscopic balloon dilation of strictures after laparoscopic gastric bypass

Objective  Stricture formation at the gastrojejunal anastomosis is a relatively common complication after laparoscopic Roux-en-Y gastric bypass (LRYGB). The objective of this study was to report the incidence of stomal strictures after LRYGB in our institution and report our experience with their management by endoscopic balloon dilatation. Methods  This is a retrospective study of 1012 patients who underwent LRYGB from January 2001 to May 2004. Patients with nausea and vomiting after the surgery, suspected of having gastrojejunal (GJ) anastomotic stricture, had upper endoscopy. Stomas less than 10 mm in diameter, or those not allowing passage of the scope were considered significant strictures and were treated with balloon dilations. Dilations were performed with a through-the-scope (TTS) balloon, with sizes ranging from 6 to 18 mm. The following data were collected from these patients: age, sex, body mass index (BMI), comorbidities, size of balloon catheter, time from surgery until symptoms onset, number of endoscopies needed to relief symptoms, and complications of the procedure. Results  Sixty-one patients (46 females and 15 males) were found to have anastomotic strictures, corresponding to an incidence of 6%. In total, 134 upper endoscopies were performed, with 128 dilatations. The average age was 41.7 years (range: 19–68 years); mean preoperative BMI was 45 kg/m² (range: 42–61 kg/m²). Mean time from surgery to symptoms onset was 2 months (range: 1–6 months). The number of dilations per patient was as follows: a single dilation in 28% of patients, two dilations in 33%, three dilations in 26%, four dilations in 11.5%, and five dilations in 1.5% of patients. All the patients responded to dilation without need for formal surgical revision. However, after balloon dilatation three patients (4.9%), all females, had bowel perforation by radiological criteria (free air on X-ray), which corresponded to 2.2% of all dilatations. The maximum balloon size used in this group was 13.5 mm. All three patients had exploratory laparoscopy without finding of perforation site. They were treated with bowel rest, intravenous antibiotics for 7 days, and drain placement. No factors were identified to predict a risk of perforation. Conclusion  This is the largest study to evaluate the outcome of endoscopic dilatations of GJ strictures after RYGB. Endoscopic balloon dilation is a safe and effective treatment for anastomotic strictures. However, it carries a small risk of perforation. Further case studies are needed to determine risk factors for perforation and if the patients can be managed conservatively in this setting.     

内镜乳头气囊扩张术对胆管结石患者的疗效观察

目的 评价内镜乳头气囊扩张术(endoscopic papillary balloon dilatation,EPBD)对胆管结石患者的疗效.方法 对2000年1月至12月406例接受ERCP治疗的胆管结石患者,按入院时间分两组,EST组205例,EPBD组201例,ERCP时分别行EST和EPBD取石.观察两组在早期并发症、结石清除率、远期并发症等方面的差异.结果 两组的早期并发症发生率、结石清除率、胰腺炎发生率比较,差异无统计学意义(χ2=0.540,0.058,0.010,P＞0.05).EST组的胆囊炎发生率和结石复发率高于EPBD组(χ2=4.002,4.263,P＜0.05).结论 行EPBD治疗胆囊炎发生率和结石复发率明显低于EST,对Oddi括约肌的保护作用也明显优于EST.     

经皮肾穿刺顺行球囊扩张治疗移植肾输尿管梗阻

目的探讨经皮肾穿刺顺行球囊扩张治疗移植肾输尿管梗阻的安全性和疗效。方法回顾性分析2007年至2011年华中科技大学附属协和医院6例接受经皮肾穿刺顺行球囊扩张治疗移植肾输尿管梗阻的患者资料。所有患者先行B超引导移植肾穿刺造瘘,顺行造影确定梗阻的具体位置,顺行球囊扩张输尿管狭窄段,术后留置双J管和肾造瘘管,无效则改开放手术。结果6例患者中1例输尿管狭窄段〉1cm,球囊扩张失败,1例合并尿瘘,尿囊肿,扩张治疗无效,此2例均经开放手术治愈;其余4例一次扩张治愈,随访16～38个月,肾功能正常,无梗阻复发。结论经皮肾穿刺顺行球囊扩张安全、损伤小,可作为治疗移植肾输尿管梗阻的首选方法,对于合并有其他外科并发症或扩张治疗失败的患者,需开放手术治疗。     

十二指肠乳头球囊扩张术及十二指肠乳头括约肌切开术治疗胆源性胰腺炎疗效的Meta分析

目的 评价十二指肠乳头球囊扩张术及十二指肠乳头括约肌切开术治疗胆源性胰腺炎的疗效.方法 通过检索近10年PubMed、Cochrane Library、Medline、Web of Science、万方数据库、维普中文科技期刊全文数据库、中国学术期刊全文数据库,对纳入研究的方法学进行评价.研究者对纳入文献的质量进行严格评价和资料提取,使用Review manager 5.0软件对符合质量标准的RCTs行Meta分析.结果 6个RCT共546名病人纳入研究,其中治疗组(十二指肠乳头球囊扩张术)273例,对照组(十二指肠乳头括约肌切开术)273例,两组病人均行常规对症支持治疗.Meta分析结果显示:治疗组与对照组相比,病人术后1d腹痛情况及术后1年复发胆管结石的差异具有统计学意义.结论 十二指肠乳头球囊扩张术可显著提升胆源性胰腺炎的疗效、改善预后.     

Management of pyloric stricture in children: endoscopic balloon dilatation and surgery

Background

Surgical correction is the most preferred treatment modality in pyloric stricture (PS). Recently a few studies reported the experience of balloon dilation in children with PS. This study was designed to present our experiences of the management of the patients with PS with balloon dilation and corrective surgery.

Methods

The records of 14 patients who were treated with the diagnosis of PS between August 2003 and August 2011 were reviewed retrospectively.

Results

There were nine boys and five girls (mean age, 3.4?±?1.7?years). The history of caustic ingestion was detected in eight patients; six of them were admitted on the day of ingestion. Two patients were admitted with nonbilious vomiting more than 2?weeks after ingestion. Four patients did not have a remarkable medical history, including caustic ingestion. They admitted with the complaint of nonbilious vomiting. PS was detected during endoscopy in two patients who had a diagnosis of peptic ulcer disease. PS was shown by barium meal study in all patients. Endoscopy was performed in all patients. Endoscopic balloon dilation was tried in 12 patients. Overall eight patients required surgical procedures for PS. The complaints were resolved by endoscopic balloon dilation of pylorus in the remaining six patients.

Conclusions

Although endoscopic balloon dilatation for benign PS in adults is a generally accepted method of treatment, there is less experience with endoscopic balloon dilatation for PS in children. PS due to benign disorders can be effectively and successfully treated through endoscopic balloon dilatation in suitable patients. In patients with successful pyloric balloon dilatation, surgery can be avoided.     

Combined endoscopic and fluoroscopic balloon dilatation of a complex proximal jejunal stricture

Dilatation of esophageal strictures has been practiced for many years. More recently, balloon dilatation, with endoscopic guidance, has been applied to the stomach and the colon. The small bowel has been less accessible to the endoscope, and, as far as we have been able to determine, balloon dilatation of jejunal strictures has not been reported. We present a patient who was referred to us after curative resection of two abdomino-pelvic malignancies, external beam irradiation to the abdomen and pelvis, and multiple later operations for bowel obstruction and dehiscence of intestinal anastomoses. The bowel obstruction and anastomotic dehiscence occurred during the present hospitalization and resulted finally in the development of a high-output proximal jejunal fistula. The area of stricture, as seen by means of barium contrast, had two separate components with an associated acute angulation. We report the combined use of endoscopic and fluoroscopic manipulation and balloon dilatation of this complex stricture.     

Management of post-radical prostatectomy anastomotic stricture by endoscopic transurethral balloon dilatation

OBJECTIVE: Anastomotic strictures are seen more commonly with increasing treatment of prostate cancer by means of radical prostatectomy. In view of the proximity to the sphincter, anastomotic strictures need careful management to avoid making the patient incontinent. We describe our experience with a novel method. MATERIAL AND METHODS: Nine patients who had developed anastomotic strictures were treated with endoscopic transurethral balloon dilatation. A catheter was left in place for 24 h postoperatively. RESULTS: Eight patients were treated successfully and remained well after a median follow-up period of 33 months. There were no complications and all patients remained continent. CONCLUSION: This is a safe and effective procedure that should be used as a first-line treatment for the management of anastomotic strictures, with transurethral incision being reserved for non-responders.     

Outcomes of balloon dilation for the treatment of strictures after endoscopic submucosal dissection compared with peptic strictures

Background

The outcomes of balloon dilation for the treatment of strictures caused by endoscopic submucosal dissection (ESD) have not been evaluated previously. This study was designed to evaluate and compare the effectiveness and complications of balloon dilation for post-ESD strictures and peptic strictures.

Methods

The medical records of 14 patients with post-ESD strictures and 48 patients with peptic strictures who underwent fluoroscopically or endoscopically guided balloon dilation between January 1997 and April 2011 at the Asan Medical Center in Korea were reviewed retrospectively.

Results

The technical success rates (defined as successful dilation without major complications) of the post-ESD and peptic stricture groups were 92.9 % (13/14) and 93.8 % (45/48), respectively (p = 1.000). For the post-ESD and peptic stricture groups, the clinical success rates (defined as symptom improvement, as determined by the patient) at 1 month were 92.9 % (13/14) and 83.3 % (40/48), respectively (p = 0.67). Their clinical success rates at 6 months were 71.4 % (10/14) and 70 % (28/40), respectively (p = 1.000). The mean weight gains of the post-ESD stricture group 1 and 6 months after balloon dilation were 1.1 and 4.8 kg, respectively, whereas the peptic group gained 1.4 and 3.4 kg, respectively (p = 0.814). All complications were perforations. The complication rates of the post-ESD and peptic stricture groups were 7.1 % (1/14) and 10.5 % (5/48), respectively (p = 1.000).

Conclusions

Balloon dilation is an effective and safe treatment for post-ESD strictures.     

Percutaneous transhepatic balloon dilatation of benign bilioenteric strictures: long-term results in 110 patients

BackgroundPercutaneous transhepatic balloon dilatation is an alternative to surgery when benign bilioenteric strictures (BBES) are inaccessible to endoscopic treatment. Our primary objective was to report long-term patency of balloon-dilated BBES.MethodsA total of 110 consecutive patients with 155 BBES had percutaneous transhepatic complete drainage of all biliary territories, balloon dilatation, and catheter stenting. Intracorporeal electrohydraulic lithotripsy treated associated biliary stones. Biliary drains were removed when no residual balloon waists were observed on at least 2 consecutive sessions, 6 weeks apart.ResultsA total of 109 of 110 patients had complete drainage. Forty-five patients had successfully treated associated stones. Eleven patients had short-term complications. No patients died. The median follow-up period was 59 months (range, .5–278 mo). Twenty-three patients were lost to follow-up evaluation. Thirteen patients had recurrent biliary obstruction (15%). Life-table analysis showed 90.9% bilioenteric patency after 2,697 days.ConclusionsPercutaneous balloon dilatation and calibration of BBES provides acceptable morbidity and low long-term stricture recurrence.