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Peña-Vélez R, Roldán-Montijo M, Imbett-Yepez S, Ramírez-Mayans J, Loredo-Mayer A, Montijo-Barrios E. Endoscopic Balloon Dilation of Gastric Stenosis secondary to Polyarteritis Nodosa and Arterial Thrombosis in an Adolescent. JPGN REPORTS 2022; 3:e198. [PMID: 37168903 PMCID: PMC10158308 DOI: 10.1097/pg9.0000000000000198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 01/13/2022] [Indexed: 05/13/2023]
Abstract
A 13-year-old female with polyarteritis nodosa underwent a partial gastrectomy for ischemic necrosis and gastric perforation following left gastric artery thrombosis. She later presented with vomiting, early satiety, weight loss, and severe malnutrition, when she was diagnosed with an occlusive gastric stricture. She successfully underwent repeated therapeutic endoscopic balloon dilations until the endpoint of 15-18 mm lumen was achieved without any complications, and her symptoms resolved.
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Affiliation(s)
- Rubén Peña-Vélez
- From the Department of Pediatric Gastroenterology and Nutrition, Instituto Nacional de Pediatría. Mexico City, Mexico
- School of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Mariana Roldán-Montijo
- From the Department of Pediatric Gastroenterology and Nutrition, Instituto Nacional de Pediatría. Mexico City, Mexico
- School of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Sharon Imbett-Yepez
- From the Department of Pediatric Gastroenterology and Nutrition, Instituto Nacional de Pediatría. Mexico City, Mexico
- School of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Jaime Ramírez-Mayans
- From the Department of Pediatric Gastroenterology and Nutrition, Instituto Nacional de Pediatría. Mexico City, Mexico
- School of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Alejandro Loredo-Mayer
- From the Department of Pediatric Gastroenterology and Nutrition, Instituto Nacional de Pediatría. Mexico City, Mexico
| | - Ericka Montijo-Barrios
- From the Department of Pediatric Gastroenterology and Nutrition, Instituto Nacional de Pediatría. Mexico City, Mexico
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Alrashidi I, Park R, Alhazemi A, Shin JH. Fluoroscopically guided balloon dilation of esophageal stricture in Plummer–Vinson syndrome: A report of two cases. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2020. [DOI: 10.18528/ijgii190024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ibrahim Alrashidi
- Department of Radiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Rohee Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Almoaiad Alhazemi
- Department of Radiology, King Fahad Central Hospital, Jazan, Saudi Arabia
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Bi Y, Li J, Chen H, Han X, Wu G, Ren J. Fluoroscopic guidance biopsy for severe anastomotic stricture after esophagogastrostomy of esophageal carcinoma: A STROBE-compliant article. Medicine (Baltimore) 2018; 97:e12316. [PMID: 30212973 PMCID: PMC6156039 DOI: 10.1097/md.0000000000012316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
To determine the safety and effectiveness of fluoroscopic guidance biopsy in the diagnosis of serve anastomotic stricture after esophagogastrostomy for esophageal carcinoma.A total of 55 patients with severe anastomotic stricture were enrolled for forceps biopsy between June 2013 and July 2017. Chest computed tomography (CT) and esophagogram were used to determine the location and extent of stricture. Specimens were collected from the site of stricture by using biopsy forceps under fluoroscopic guidance. Stooler's dysphagia score was compared before and after treatment.The technical success rate of fluoroscopic guidance biopsy was 100%, with no serious complications occurred. A total of 38 patients were diagnosed as benign stricture, of which, 2 patients were further diagnosed as cancer by further biopsy, with a missed diagnosis rate of 5.3%, and 1 patient developed squamous cell carcinoma after 5 months. Thus 20 cases were diagnosed as cancer, 3 cases were adenocarcinoma and 17 cases were squamous cell carcinoma. Balloon dilation was performed for 20 patients (33 times) of benign stricture, and 9 patients (10 times) of malignant stricture. A total of 26 esophageal covered stents were implanted for benign restenosis after repeated balloon dilation. A total of 8 esophageal covered stents were implanted for malignant stricture. After esophagus stenting, dysphagia was immediately alleviated. The dysphagia score decreased from 3.4 ± 0.1 to 0.7 ± 0.1 (P < .001) after treatment.Fluoroscopic guidance biopsy is a safe and effective procedure for directing appropriate treatment of anastomotic stricture after esophagogastrostomy, and it may be an alternative approach for patients who cannot tolerate fibergastroscopy.
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Affiliation(s)
| | - Jindong Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University
| | - Hongmei Chen
- Department of Ultrasound, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | | | - Gang Wu
- Department of Interventional Radiology
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Kim JE, Kim HC, Lee M, Hur S, Kim M, Lee SH, Cho SB, Kim CS, Han JK. Efficacy of Retrievable Metallic Stent with Fixation String for Benign Stricture after Upper Gastrointestinal Surgery. Korean J Radiol 2016; 17:893-902. [PMID: 27833405 PMCID: PMC5102917 DOI: 10.3348/kjr.2016.17.6.893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/31/2016] [Indexed: 11/21/2022] Open
Abstract
Objective To determine the efficacy of retrievable metallic stent with fixation string for benign anastomotic stricture after upper gastrointestinal (UGI) surgery. Materials and Methods From June 2009 to May 2015, a total of 56 retrievable metallic stents with fixation string were placed under fluoroscopy guidance in 42 patients who were diagnosed with benign anastomotic stricture after UGI surgery. Clinical success was defined as achieving normal regular diet (NRD). Results The clinical success rate after the first stent placement was 57.1% (24/42). After repeated stent placement and/or balloon dilation, the clinical success rate was increased to 83.3% (35/42). Six (14.3%) patients required surgical revision to achieve NRD. One (2.4%) patient failed to achieve NRD. Stent migration occurred in 60.7% (34/56) of patients. Successful rate of removing the stent using fixation string and angiocatheter was 94.6% (53/56). Distal migration occurred in 12 stents. Of the 12 stents, 10 (83.3%) were successfully removed whereas 2 could not be removed. No complication occurred regarding distal migration. Conclusion Using retrievable metallic stent with a fixation string is a feasible option for managing early benign anastomotic stricture after UGI surgery. It can reduce complications caused by distal migration of the stent.
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Affiliation(s)
- Jeong-Eun Kim
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Myungsu Lee
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Saebeom Hur
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Minuk Kim
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Sang Hwan Lee
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Soo Buem Cho
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Chan Sun Kim
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea
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Chung KH, Lee SH, Park JM, Lee JM, Shin CM, Ahn SH, Park DJ, Kim HH, Ryu JK, Kim YT. Partially covered self-expandable metallic stent for postoperative benign strictures associated with laparoscopy-assisted gastrectomy. Gastric Cancer 2016; 19:280-6. [PMID: 25503478 DOI: 10.1007/s10120-014-0450-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 11/24/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND A partially covered self-expandable metallic stent (PCSEMS) is of proven benefit in palliation of unresectable or inoperable malignant gastric outlet obstruction. However, its use in patients with benign anastomotic stricture after laparoscopy-assisted gastrectomy (LAG) is not well established. METHODS Patients who between May 2007 and June 2012 underwent PCSEMS placement for management of benign gastrointestinal obstruction after LAG were included in this retrospective analysis. The primary outcomes were the technical success and clinical success of the PCSEMS. The secondary outcomes were procedure-related complications and PCSEMS dysfunction. RESULTS Eleven patients (six women, five men, mean age 53.5 years, range 15-76 years) underwent successful placement of a PCSEMS for management of benign anastomotic strictures after LAG and were followed-up for a mean of 20.6 months (range 7.9-55.6 months). The mean gastric outlet obstruction scoring system (GOOSS) score was 0.36 before PCSEMS placement and 1.55 (p = 0.010) 24-48 h after PCSEMS placement. All of the patients were able to tolerate a solid diet (GOOSS score 3) after 1 week. There were no major or minor procedure-related complications. Stent dysfunction occurred in four patients (three distal migrations, one proximal migration), and stent removal was successful in all of the remaining patients after a mean of 2.0 months (1.1-3.0 months). Obstructive symptoms recurred in two patients (one after proximal migration, one after stent removal) and were treated successfully with PCSEMS reinsertion and balloon dilation. CONCLUSIONS A PCSEMS may be a feasible and effective option for management of benign anastomotic strictures after LAG which could avoid secondary surgery.
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Affiliation(s)
- Kwang Hyun Chung
- Division of Gastroenterology, Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
| | - Sang Hyub Lee
- Division of Gastroenterology, Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
| | - Jin Myung Park
- Division of Gastroenterology, Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
| | - Jae Min Lee
- Division of Gastroenterology, Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-Do, 463-707, Korea.
| | - Sang Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-Do, 463-707, Korea.
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-Do, 463-707, Korea.
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-Do, 463-707, Korea.
| | - Ji Kon Ryu
- Division of Gastroenterology, Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
| | - Yong-Tae Kim
- Division of Gastroenterology, Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
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Adverse events associated with endoscopic dilation for gastric stenosis after endoscopic submucosal dissection for early gastric cancer. Surg Endosc 2015; 29:3776-82. [PMID: 25783836 DOI: 10.1007/s00464-015-4153-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/06/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND Gastric stenosis is a major problem after endoscopic submucosal dissection (ESD) for large early gastric cancer, but little is known about the incidence of adverse events associated with endoscopic dilation (ED) for stenosis caused by gastric ESD. The aims of this study were to determine the incidence and risk of bleeding and perforation associated with ED for gastric stenosis after ESD. METHODS This was a single-center, retrospective cohort study conducted at a specialized center for treating cancer. A total of 342 procedures of wire-guided balloon ED were performed for stenosis after gastric ESD in 64 patients. The incidence of adverse events and related clinical characteristics was analyzed. RESULTS The incidence of bleeding was 3.1% (2/64) per patient and 0.6% (2/342) per procedure. One bleeding case with incomplete cessation of antithrombotics before ED required blood transfusion. The incidence of perforation was 7.8% (5/64) per patient and 1.5% (5/342) per procedure. All perforations occurred in the lower part of the stomach. Two of the five perforation cases were inappropriate for nonoperative therapy, and thus, emergency surgery was performed. Among the other three perforation cases, one case required surgery for refractory stenosis and ED was continued in one case after nonoperative therapy. CONCLUSIONS The incidence of bleeding caused by ED for gastric stenosis after ESD was small. Although not significant, ED in the lower stomach presents a substantial risk of perforation.
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Interventional management of benign strictures of the gastrointestinal tract from the stomach to the colon. GASTROINTESTINAL INTERVENTION 2013. [DOI: 10.1016/j.gii.2013.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Outcomes of balloon dilation for the treatment of strictures after endoscopic submucosal dissection compared with peptic strictures. Surg Endosc 2013; 27:3237-46. [PMID: 23479256 DOI: 10.1007/s00464-013-2900-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 02/15/2013] [Indexed: 01/14/2023]
Abstract
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.
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The outcome of fluoroscopically guided balloon dilation of pyloric stricture in Crohn disease. J Vasc Interv Radiol 2011; 22:1153-8. [PMID: 21570874 DOI: 10.1016/j.jvir.2011.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 03/04/2011] [Accepted: 03/10/2011] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To evaluate the clinical efficacy and safety of fluoroscopically guided balloon dilation for pyloric stricture associated with Crohn disease (CD) while monitoring the outcome. MATERIALS AND METHODS Five patients (age range 15-34 y) were diagnosed with symptomatic pyloric stricture associated with CD between November 2006 and August 2009. All five patients underwent fluoroscopically guided balloon dilation one or more times. RESULTS The initial balloon dilations were technically successful in all patients. Two patients showed improvement of symptoms without further need of dilation, two patients had one more session of dilation, and one patient underwent two more sessions of repeated dilation. There were no procedure-related complications. Overall technical and clinical success rates were 100%. After the last dilation, all patients remained healthy, with no case of relapse of obstructive symptoms during the median follow-up of 16 months (range 6-22 mo). CONCLUSIONS Fluoroscopically guided balloon dilation seems to be a useful tool for management of symptomatic pyloric stricture in CD and may be a viable alternative to open surgery.
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Kim JH, Shin JH, Song HY. Benign strictures of the esophagus and gastric outlet: interventional management. Korean J Radiol 2010; 11:497-506. [PMID: 20808692 PMCID: PMC2930157 DOI: 10.3348/kjr.2010.11.5.497] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 02/16/2010] [Indexed: 12/16/2022] Open
Abstract
Benign strictures of the esophagus and gastric outlet are difficult to manage conservatively and they usually require intervention to relieve dysphagia or to treat the stricture-related complications. In this article, authors review the non-surgical options that are used to treat benign strictures of the esophagus and gastric outlet, including balloon dilation, temporary stent placement, intralesional steroid injection and incisional therapy.
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Affiliation(s)
- Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Kochhar R, Kochhar S. Endoscopic balloon dilation for benign gastric outlet obstruction in adults. World J Gastrointest Endosc 2010; 2:29-35. [PMID: 21160676 PMCID: PMC2998862 DOI: 10.4253/wjge.v2.i1.29] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 09/01/2009] [Accepted: 09/08/2009] [Indexed: 02/05/2023] Open
Abstract
Gastric outlet obstruction (GOO) includes obstruction in the antropyloric area or in the bulbar or post bulbar duodenal segments. Though malignancy remains the most common cause of GOO in adults, a significant number of patients have benign disease. The latter include peptic ulcer disease, caustic ingestion, post-operative anastomotic state and inflammatory causes like Crohn’s disease and tuberculosis. Peptic ulcer remains the most common benign cause of GOO. Management of benign GOO revolves around confirmation of the etiology, removing the offending agent Helicobacter pylori (H. pylori), non-steroidal anti-inflammatory drugs, etc. and definitive therapy. Traditionally, surgery has been the standard mode of treatment for benign GOO. However, after the advent of through-the-scope balloon dilators, endoscopic balloon dilation (EBD) has emerged as an effective alternative to surgery in selected groups of patients. So far, this form of therapy has been shown to be effective in caustic-induced GOO with short segment cicatrization and ulcer related GOO. In the latter, EBD must be combined with eradication of H. pylori. Dilation is preferably done with wire-guided balloon catheters of incremental diameter with the aim to reach the end-point of 15 mm. While it is recommended that fluoroscopic control be used for EBD, this is not used by most endoscopists. Frequency of dilation has varied from once a week to once in three weeks. Complications are uncommon with perforation occurring more often with balloons larger than 15 mm. Attempts to augment efficacy of EBD include intralesional steroids and endoscopic incision.
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Affiliation(s)
- Rakesh Kochhar
- Rakesh Kochhar, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Kim JH, Shin JH, Song HY. Fluoroscopically guided balloon dilation for benign anastomotic stricture in the upper gastrointestinal tract. Korean J Radiol 2009; 9:364-70. [PMID: 18682675 PMCID: PMC2627276 DOI: 10.3348/kjr.2008.9.4.364] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Kim JH, Song HY, Park SW, Yoon CJ, Shin JH, Yook JH, Kim BS. Early symptomatic strictures after gastric surgery: palliation with balloon dilation and stent placement. J Vasc Interv Radiol 2008; 19:565-70. [PMID: 18375302 DOI: 10.1016/j.jvir.2007.11.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2007] [Revised: 11/05/2007] [Accepted: 11/15/2007] [Indexed: 12/16/2022] Open
Abstract
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.
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Affiliation(s)
- Jin Hyoung Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap-2dong, Songpa-gu, Seoul 138-736, Republic of Korea
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Kim JH, Song HY, Shin JH, Kim TW, Kim KR, Kim SB, Park SI, Kim JH, Choi E. Palliative treatment of unresectable esophagogastric junction tumors: balloon dilation combined with chemotherapy and/or radiation therapy and metallic stent placement. J Vasc Interv Radiol 2008; 19:912-7. [PMID: 18503907 DOI: 10.1016/j.jvir.2008.02.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2007] [Revised: 11/18/2007] [Accepted: 02/24/2008] [Indexed: 12/16/2022] Open
Abstract
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.
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Affiliation(s)
- Jin Hyoung Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea
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Kim JH, Song HY, Kim HC, Shin JH, Kim KR, Park SW, Jung HY, Lee GH, Park SI. Corrosive esophageal strictures: long-term effectiveness of balloon dilation in 117 patients. J Vasc Interv Radiol 2008; 19:736-41. [PMID: 18440463 DOI: 10.1016/j.jvir.2008.01.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Revised: 01/17/2008] [Accepted: 01/18/2008] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To retrospectively evaluate the long-term results of balloon dilation in the treatment of corrosive esophageal strictures and to identify prognostic factors associated with clinical outcome. MATERIALS AND METHODS From January 1987 to June 2006, balloon dilation was undertaken in 117 patients with corrosive esophageal strictures. Information on recurrence and complications was obtained. Recurrence rates and factors predicting recurrences were evaluated with Kaplan-Meier survival analysis and Cox multivariate analysis. Tested variables were age, sex, corrosive agent, stricture length, stricture number, severity of stricture as judged by the resistance to dilation, and stage (early chronic [3 weeks to 6 months] vs late chronic [>6 months]). RESULTS The mean follow-up period was 51 months (range, 1-174 months). Thirty patients (26%) had no recurrence after initial balloon dilation. Twenty-three patients (20%) experienced no recurrence after one or two additional balloon dilation procedures. Forty-five of 117 patients (38%) experienced esophageal rupture (mostly intramural rupture). Early chronic stage (P=.003) and resistance to balloon dilation in the late chronic stage (P=.034) were significantly associated with recurrence after balloon dilation. CONCLUSIONS Balloon dilation is associated with minimal complications and is valuable as an initial therapy in patients with corrosive esophageal stricture. However, the recurrence rate after balloon dilation is rather high, with early chronic stage and resistance to dilation in the late chronic stage associated with poor clinical outcome. An algorithm combining balloon dilation with temporary stent placement is proposed for the subsets of patients prone to stricture recurrence.
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Affiliation(s)
- Jin Hyoung Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul National University Hospital, Seoul, Korea
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Keeling AN, Davis JL, Williams A, Sabharwal T, Adam A. Fluoroscopically guided balloon dilation of NSAID-induced colonic diaphragm. J Vasc Interv Radiol 2007; 18:1060-2. [PMID: 17675630 DOI: 10.1016/j.jvir.2007.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
PURPOSE OF REVIEW To examine the short and long-term success rates of balloon dilation of pyloric stenosis. RECENT FINDINGS Several large studies have demonstrated high rates of success for the relief of symptoms from pyloric stenosis using through-the-scope balloons. These dilating balloons readily increase the diameter of the stenotic pylorus on average from 6 to 16 mm. Patients who require more than two dilations are at high risk of endoscopic failure and the need for surgical intervention. Rapid re-stenosis rates are observed in patients with malignant pyloric obstruction. Since many patients with benign pyloric stenosis have underlying ulcer disease, helicobacter infection is a relatively common finding. Eradication of this infection at the time of balloon dilation will ensure higher long-term success rates. SUMMARY In summary, benign pyloric stenosis can be readily treated with endoscopic balloon dilation and should be the first-line therapy.
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Affiliation(s)
- Tony E Yusuf
- GI Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
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