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.     

Boston专用球囊扩张治疗贲门失弛缓症107例报告

目的总结Boston专用扩张球囊治疗贲门失弛缓症105例的方法与疗效。方法在电视监视下经口腔置入加强导丝,并经导丝引入球囊于贲门狭窄部,狭窄严重者需用20～25 mm球囊预扩张。手推法球囊内注入15%造影剂,将球囊循序渐进与间断性扩张至球囊存在小切迹为止。持续5 m in后松解,3～5 m in后再扩张,连续2~3次。结果 105例球囊扩张成功率100%,13例2次扩张,1例无效和1例破裂手术,术后随访2周~6年,总有效率98%。结论采用直径40 mm专用球囊治疗贲门失弛缓症,方法简单、疗效可靠,可以取代外科手术。     

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.     

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。     

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.     

双球囊组合扩张术治疗贲门失弛缓症的临床研究

目的　评价双球囊组合扩张术治疗贲门失弛缓症的疗效及其价值。方法　采用双球囊组合扩张术治疗贲门失弛缓症患者 5 2例。结果　近期有效率 10 0 % ,远期有效率 ,1次扩张 96 % ,2次扩张 10 0 %。结论　双球囊组合扩张术是治疗贲门失弛缓症安全有效 ,易于操作的方法。     

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.     

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.     

不同直径暂时性贲门支架成形术治疗贲门失弛缓症的远期随访

目的通过长期随访研究探讨不同直径暂时性贲门支架成形术治疗贲门失弛缓症远期疗效。方法135例贲门失弛缓症患者根据暂时性贲门支架直径分为3组,其中20 mm组(A组)30例;25 mm组(B组)30例;30 mm组(C组)75例。135例贲门失弛缓症患者中放置135枚暂时性贲门支架。支架放置后3～5 d,采用内镜取出。所有支架安放和取出成功率100%,无操作死亡。结果3组介入治疗前后贲门管腔直径、吞咽困难评分差异都有显著性(P＜0．01)。A组随访半年、1、3、5、8和10年以上患者吞咽困难复发率分别为6/30(20．0%)、6/30(20．0%)、5/22(22．7%)、6/16(37．5%)、5/9和3/3;B组随访大于等于半年、1、3、5、8年和10年以上患者吞咽困难复发率分别为4/30(13．3%)、4/30(13．3%)、3/23(13．0%)、4/18 (22．2%)、5/11(45．5%)和3/4;C组随访大于等于半年、1、3、5、8年和10年以上患者吞咽困难复发率分别为0/75(0%)、1/66(1．5%)、4/48(8．3%)、6/33(18．2%)、6/18(33．3%)和2/5。结论30 mm直径作暂时性贲门支架成形术是贲门失弛缓症暂时性支架成形术中的最佳选择。     

Balloon dilation of anastomotic strictures secondary to surgical repair of esophageal atresia in a pediatric population: long-term results

PURPOSE: To evaluate the clinical effectiveness and long-term results of balloon dilation treatment for strictures secondary to surgical repair of esophageal atresia (EA) in 29 children. MATERIALS AND METHODS: The study involved 29 children aged 1-60 months with strictures of greater than 50% at anastomotic sites. The interval between surgical repair and balloon dilation ranged from 1 to 36 months (mean, 6.4 months). All procedures were performed under general anesthesia with use of fluoroscopic guidance. Balloon catheter diameters ranged from 8 mm to 16 mm. Outcome parameters measured included the number of dilations, procedural success rates, primary and secondary clinical success rates, and complications such as esophageal perforation. Primary clinical success was defined as an absence of dysphagia for at least 1 year and weight gain appropriate to the patient's age after initial balloon dilation. Secondary clinical success was defined as an absence of dysphagia for at least 1 year after the final dilation and weight gain appropriate to the patient's age after one or more balloon dilation sessions. RESULTS: A total of 44 balloon dilation sessions were performed, with patients undergoing one to five dilation procedures (mean, 1.6 per patient; median, 1 per patient). Primary and secondary clinical success rates were 59% (17 of 29) and 93% (27 of 29), respectively. During the mean follow-up period of 3.1 years (range, 1-12 y), all 27 children with clinical success showed no recurring symptoms. In terms of complications, transmural perforation occurred in three children (10%), two of whom received conservative management and one of whom underwent surgery for combined esophageal rupture and esophagotracheal fistula. No mortalities occurred. CONCLUSION: Balloon dilation is a safe and effective procedure with excellent long-term results for the treatment of anastomotic strictures secondary to surgical repair of EA in a pediatric population.     

带囊导管扩张术治疗贲门失弛缓症95例经验总结

本文报告带囊导管扩张术治疗贲门失弛缓症９５例，近期效果显著，远期有效者为９５．７６％。作者强调对贲门失弛缓症实施扩张球囊的直径不得小于４．０ｃｍ（儿童患者酌减），提出影响疗效的因素与患者的病程、年龄以及贲门狭窄的程度有关。对本病大球囊扩张的原理、疗效及并发症进行了探讨，认为可将扩张法作为贲门失弛缓症的首选疗法。     

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.     

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.     

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.     

自制贲门扩张器治疗贲门失弛症（附110例报告）

贲门扩张器由硅胶引导管、乳胶尼龙网气囊、不锈钢弹簧塑胶包皮管、开口器、硅胶连接管、开关及针座组成。结构简单、操作方便。用该扩张器在Ｘ线电视监视下扩张治疗贲门失弛症１１０例，有效率１００％，治愈率９６％。未发生返流性食管炎、穿孔等并发症。经５年３个月随访无复发。可作为贲门失弛的首选疗法。     

食管-胃吻合口严重瘢痕性狭窄大球囊过度扩张治疗

目的探讨大球囊扩张成形治疗食管-胃吻合口严重瘢痕性狭窄的疗效和价值。方法透视下应用直径27～30mm的大球囊导管对36例食管-胃吻合口瘢痕性狭窄患者进行扩张治疗。结果26例(72．2％)一次性扩张治愈,8例(22．2％)扩张2次,2例(5．6％)扩张3次。术后随访6～40个月,吞咽困难缓解率100％,均无严重并发症和复发。结论利用大球囊扩张成形治疗食管一胃吻合口瘢痕性狭窄安全、有效,可取代内支架置入达到根治目的,值得大力推广。     

Esophageal strictures: balloon dilation

One hundred seventy transnasal balloon catheter dilation procedures were performed in 35 patients with esophageal strictures to assess the efficacy and safety of the procedure. On the average, five dilations were required per patient. Depending on the cause of the esophageal stricture, success rates for the technique ranged from 67% to 87%, with success defined as the resolution of dysphagia to both fluids and solids. Three complications, all perforations, were seen; one perforation required surgical repair. No procedure-related deaths were identified in this series. Balloon catheter dilation can be safely applied to esophageal strictures from a variety of causes, with a high degree of clinical success.     

Percutaneous transhepatic balloon dilation of portal venous stenosis in patients with living donor liver transplantation

PURPOSE: To retrospectively evaluate the long-term effectiveness of percutaneous transhepatic balloon dilation of portal venous stenosis in patients who have undergone living donor liver transplantation. MATERIALS AND METHODS: Institutional review board approval and informed consent were not required. From June 1996 to August 2003, obstructed portal venous blood flow was diagnosed in 45 patients (21 male, 24 female) with a history of living donor liver transplantation; patients ranged in age from 9 months to 61 years (mean, 9.2 years). All stenoses occurred in the extrahepatic portal vein near the anastomosis of the portal vein. All dilation procedures were performed with percutaneous transhepatic puncture of the intrahepatic portal vein and subsequent balloon dilation of the stenosis. Patients who experienced recurrent stenosis underwent another balloon dilation session. Intravascular metallic stents were not deployed because of the possible need for repeated transplantation. The authors used paired t tests to compare patients successfully treated with one venoplasty procedure and those requiring repeated venoplasty, with regard to age and stenosis diameter percentages before and after the initial procedure. RESULTS: Percutaneous balloon dilation was technically successful in 35 of 45 patients. In the remaining 10 patients, portal venous thrombotic occlusion precluded access to the mesenteric side of the portal vein. Twenty-five patients were successfully treated with a single session of balloon dilation (group 1). Results at follow-up ultrasonography revealed restenosis in 10 of 35 patients. Recurrent stenosis was resolved by means of repeated balloon dilation in nine patients (group 2). There were no significant differences between groups 1 and 2 in age (P = .87) or in stenosis diameter percentages before (P = .053) or after (P = .95) the initial procedure. CONCLUSION: Percutaneous transhepatic balloon dilation seems to be an effective method for treatment of portal venous stenosis after living donor liver transplantation.     

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。     

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。