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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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Youn BJ, Kim WS, Cheon JE, Kim WY, Shin SM, Kim IO, Yeon KM. Balloon dilatation for corrosive esophageal strictures in children: radiologic and clinical outcomes. Korean J Radiol 2010; 11:203-10. [PMID: 20191068 PMCID: PMC2827784 DOI: 10.3348/kjr.2010.11.2.203] [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: 09/25/2009] [Accepted: 11/20/2009] [Indexed: 12/21/2022] Open
Abstract
Objective We retrospectively evaluated the effectiveness of the esophageal balloon dilatation (EBD) in children with a corrosive esophageal stricture. Materials and Methods The study subjects included 14 patients (M:F = 8:6, age range: 17-85 months) who underwent an EBD due to a corrosive esophageal stricture. The causative agents for the condition were glacial acetic acid (n = 9) and lye (n = 5). Results A total of 52 EBD sessions were performed in 14 patients (range 1-8 sessions). During the mean 15-month follow-up period (range 1-79 months), 12 patients (86%) underwent additional EBD due to recurrent esophageal stricture. Dysphagia improved after each EBD session and oral feeding was possible between EBD sessions. Long-term success (defined as dysphagia relief for at least 12 months after the last EBD) was achieved in two patients (14%). Temporary success of EBD (defined as dysphagia relief for at least one month after the EBD session) was achieved in 17 out of 52 sessions (33%). A submucosal tear of the esophagus was observed in two (4%) sessions of EBD. Conclusion Only a limited number of children with corrosive esophageal strictures were considered cured by EBD. However, the outcome of repeated EBD was sufficient to allow the children to eat per os prior to surgical management.
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Affiliation(s)
- Byung Jae Youn
- Department of Radiology, Seoul National University College of Medicine and the Institute of Radiation Medicine, SNUMRC, Seoul 110-744, Korea
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Radiologically guided balloon dilatation of neopharyngeal strictures following total laryngectomy and pharyngolaryngectomy: 21 years’ experience. The Journal of Laryngology & Otology 2009; 124:175-9. [DOI: 10.1017/s0022215109991320] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:To assess the efficacy of radiologically guided balloon dilatation for the treatment of dysphagia secondary to neopharyngeal strictures in patients who have undergone laryngectomy.Study design:Retrospective case series.Subjects and methods:Twenty consecutive patients with pharyngeal stricture and dysphagia following total laryngectomy or pharyngolaryngectomy. Patients underwent balloon dilatation of the stricture under radiological guidance. The main outcome measure was maintenance of swallowing.Results:Five patients gained relief of their dysphagia with one balloon dilatation only. Nine patients required more than one dilatation to maintain swallowing. Two patients had balloon dilatation procedures and stent insertion for palliative relief of dysphagia from known recurrent malignant disease. Three patients failed to maintain swallowing with repeat dilatations. No patients suffered any significant complications such as perforation.Conclusions:Radiologically guided balloon dilatation is minimally invasive and safe. It is well tolerated. It may be repeated frequently, and can successfully relieve pharyngeal strictures in patients who have undergone total laryngectomy or pharyngolaryngectomy.
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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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Okawada M, Okazaki T, Takahashi T, Lane GJ, Yamataka A. Gastric outlet obstruction possibly secondary to ulceration in a 2-year-old girl: a case report. CASES JOURNAL 2009; 2:8. [PMID: 19123936 PMCID: PMC2631538 DOI: 10.1186/1757-1626-2-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Accepted: 01/05/2009] [Indexed: 11/18/2022]
Abstract
Gastric outlet obstruction due to ulceration is extremely rare in childhood. We report a case of gastric outlet obstruction possibly secondary to peptic ulceration and our surgical management. Our approach, without vagotomy or antrectomy, would appear to be a safe and effective.
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Affiliation(s)
- Manabu Okawada
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
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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, 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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SPADA FLA, CASABLANCA G, BARONE M, BONARDELLI P. The Rigiflex TTS: A New Method to Dilate Benign Esophageal Stenosis. Dig Endosc 2007. [DOI: 10.1111/j.1443-1661.1991.tb00308.x] [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: 02/23/2023]
Affiliation(s)
- F. LA SPADA
- Institute of Thoracic and Cardiovascular Surgery, University of Messina, Italy
| | - G. CASABLANCA
- Institute of Thoracic and Cardiovascular Surgery, University of Messina, Italy
| | - M. BARONE
- Institute of Thoracic and Cardiovascular Surgery, University of Messina, Italy
| | - P. BONARDELLI
- Institute of Thoracic and Cardiovascular Surgery, University of Messina, Italy
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Treatment of malignant gastric outlet obstruction: endoscopic implantation of self-expanding metal stents versus gastric bypass surgery. Eur Surg 2006. [DOI: 10.1007/s10353-006-0295-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Choi GB, Shin JH, Song HY, Lee YS, Cho YK, Bae JI, Kim JH, Jeong YH, Park MH. Fluoroscopically guided balloon dilation for patients with esophageal stricture after radiation treatment. J Vasc Interv Radiol 2006; 16:1705-10. [PMID: 16371539 DOI: 10.1097/01.rvi.0000179813.93992.9e] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Gi Bok Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea
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Artifon ELA, Sakai P, Hondo FY, Lopasso FP, Ishioka S, Gama-Rodrigues JJ. An evaluation of gastric scintigraphy pre- and postpyloroduodenal peptic stenosis dilation. Surg Endosc 2006; 20:243-8. [PMID: 16391961 DOI: 10.1007/s00464-005-0129-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Accepted: 07/19/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND The usual treatment of pyloroduodenal peptic stenosis has been mainly surgical, through pyloroplasty or gastric resection, with or without vagotomy. Since the first description of treatment for this peptic complication by endoscopic balloon dilation perfomed by Benjamin in 1982 [2], this procedure has become a therapeutic option in association with the medical treatment of peptic disease. The aim of this study is to evaluate the results involving clinical, endoscopic, and gastric emptying scintigraphy parameters. METHODS Between August 1998 and February 2000, 20 patients with pyloroduodenal stenosis refractory to conservative treatment were treated at the Gastrointestinal Endoscopy Unit of the University of São Paulo Medical School. All patients who presented clinical manifestations of pyloroduodenal stenosis underwent upper gastrointestinal endoscopy to confirm peptic stenosis. Biopsy of the narrowing for the confirmation of a benign disease and gastric biopsy for Helicobacter pylori detection were performed. The treatment consisted of dilation of the stenosis with type TTS (Through The Scope) hydrostatic balloon under endoscopic control, treatment of Helicobacter pylori infection, and gastric acid suppression with oral administration of proton pump inhibitor. All patients, except one who was excluded from this study, were submitted to a clinical endoscopic assessment and gastric emptying evaluation by ingestion of (99m)Tc before and after the treatment. Endoscopic evaluation considered the diameter of the stenotic area before and after treatment. A scintigraphic study compared the time of gastric emptying before and after balloon dilation. RESULTS Nineteen patients completed treatment by hydrostatic balloon dilation. Clinical symptoms such as bloating (p < 0.0001), epigastric pain (p = 0.0159), gastric stasis (p < 0.0001), and weight gain (p = 0.036) showed significant improvement. The diameter of the stenotic area increased significantly (p < 0.01) after the dilation treatment as well as a better gastric emptying of (99m)Tc (p < 0.0001). CONCLUSION The dilation of the peptic pyloroduodenal stenosis using a hydrostatic balloon is a safe and effective procedure. The evaluation with gastric scintigraphy by ingestion of (99m)Tc is an effective method of assessment for the improvement of gastric function, because its results corresponded to the clinical improvement after endoscopic treatment.
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Affiliation(s)
- E L A Artifon
- Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil.
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Kim JH, Shin JH, Bae JI, Di ZH, Lim JO, Kim TH, Ko GY, Yoon HK, Sung KB, Song HY. Gastric outlet obstruction caused by benign anastomotic stricture: treatment by fluoroscopically guided balloon dilation. J Vasc Interv Radiol 2005; 16:699-704. [PMID: 15872325 DOI: 10.1097/01.rvi.0000153923.38343.72] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- Jin Hyoung Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Feng J, Gu W, Li M, Yuan J, Weng Y, Wei M, Zhou X. Rare causes of gastric outlet obstruction in children. Pediatr Surg Int 2005; 21:635-40. [PMID: 16041609 DOI: 10.1007/s00383-005-1472-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2005] [Indexed: 10/25/2022]
Abstract
Gastric outlet obstruction (GOO) presenting beyond the newborn period is a relatively rare condition, when infantile hypertrophic pyloric stenosis (IHPS) is excluded. This report describes the clinical features, evaluation and management of 18 patients with GOO which was not caused by IHPS. The sex, age, and main presenting features were recorded on admission. Hemoglobin estimation, serum chemistry and blood gas analysis were also assessed in these patients. The diagnosis was confirmed with gastrointestinal barium, B ultrasound, gastroscopy, or at surgery. Some of them underwent gastroscopy with biopsy sampling for rapid urease test or histologic examination with Giemsa stains for Helicobacter pylori. Thirteen patients had peptic ulcer disease, of which six were successfully treated with medications. While the other seven needed operative management which included Heineke-Mikulicz pyloroplasty, gastroduodenostomy or gastrojejunostomy, respectively. All the patients who had Heineke-Mikulicz pyloroplasty or gastrojejunostomy developed bile reflux gastritis that could be alleviated with omeprazol. None of the patients developed dumping syndrome, failing to thrive, or anemia. Three children with antral diaphragm recovered without any complications by diaphragm excision with Heineke-Mikulicz pyloroplasty. The pylorus was compressed by fibrotic band in one 30-month boy, and he recovered uneventfully with Heineke-Mikulicz pyloroplasty during 10-year follow-up. Gastric outlet obstruction secondary to ingestion of sulfuric acid was noted in one patient, and he was successfully treated with gastroduodenostomy. Our data suggests that the satisfactory results could be expected in children with GOO with different therapeutic modalities based on the specific cause and degree of obstruction.
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Affiliation(s)
- Jiexiong Feng
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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Kim JH, Shin JH, Di ZH, Ko GY, Yoon HK, Sung KB, Song HY. Benign duodenal strictures: treatment by means of fluoroscopically guided balloon dilation. J Vasc Interv Radiol 2005; 16:543-8. [PMID: 15802456 DOI: 10.1097/01.rvi.0000150033.13928.d4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Fluoroscopically guided balloon (15 or 20 mm in diameter) dilation was performed on eight patients with benign duodenal strictures caused by peptic ulcers (n = 6), Crohn's disease (n = 1), and postoperative adhesion (n = 1). The procedure was technically and clinically successful without complications in seven of the eight patients (88%). Duodenal perforation occurred immediately after 20-mm-diameter balloon dilation in one patient who underwent emergency surgery. During the mean follow-up of 30 months (range, 2-103 months), there was recurrence in two of the seven patients (29%) who then underwent surgery. The other five patients (71%) showed good results with no recurrence.
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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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Bae JI, Shin JH, Song HY, Yoon CJ, Nam DH, Choi WC, Lim JO. Use of guiding sheaths in peroral fluoroscopic gastroduodenal stent placement. Eur Radiol 2005; 15:2354-8. [PMID: 15942731 DOI: 10.1007/s00330-005-2815-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2005] [Revised: 04/10/2005] [Accepted: 04/29/2005] [Indexed: 01/30/2023]
Abstract
Our purpose was to assess the safety and usefulness of guiding sheaths in peroral fluoroscopic gastroduodenal stent placement. Two types of guiding sheath were made from straight polytetrafluoroethylene tubes. Type A was 80 cm in length, 4 mm in outer diameter and 3 mm in inner diameter. Type B was 70 cm in length, 6 mm in outer diameter and 5 mm in inner diameter. The type A sheath was used in 18 patients in whom a catheter-guide wire combination failed to pass through a stricture. The type B sheath was used in 22 patients in whom a stent delivery system failed to pass through the stricture due to loop formation within the gastric lumen. The overall success rate for guiding a catheter-guide wire through a stricture after using the type A sheath was 89%. The overall success rate for passing a stent delivery system through a stricture after using the type B sheath was 100%. All procedures were tolerated by the patients without any significant complications. The guiding sheaths were safe and useful in peroral fluoroscopic gastroduodenal stent placement.
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Affiliation(s)
- Jae-Ik Bae
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-2dong, Songpa-gu, Seoul, 138-736, Republic of Korea
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Seo TS, Song HY, Lee JH, Ko GY, Sung KB, Lim JO, Ko YH. Newly designed sheaths for gastroduodenal intervention: an experimental study in a phantom and dogs. Korean J Radiol 2004; 5:114-20. [PMID: 15235236 PMCID: PMC2698139 DOI: 10.3348/kjr.2004.5.2.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate the usefulness of newly designed sheaths for gastroduodenal intervention in a gastric phantom and dogs. Materials and Methods A regular sheath was made using a polytetrafluoroethylene tube (4 mm in diameter, 90 cm long) with a bent tip (4 cm long, 100 degree angle). For the supported type of sheath, a 5 Fr catheter was attached to a regular sheath to act as a side lumen. To evaluate their supportability, we measured the distance of movement of the sheath's tip within a silicone gastric phantom for three types of sheath, the regular type, supported type, and supported type with a supporting guide wire. The experiments were repeated 30 times, and the results were analyzed using ANOVA with the postHoc test. In addition, an animal experiment was performed in six mongrel dogs (total: 12 sessions) to evaluate the torque and supportability of the sheaths in the stomach, while pushing a guide wire or coil catheter under fluoroscopic guidance. Results In the guide wire application, the distances of movement of the sheath tip in the three types of sheath, the regular type, supported type, and supported type with supporting guide wire, were 8.40±0.51 cm, 6.23±0.41 cm, and 4.47±0.32 cm, respectively (p < 0.001). In the coil catheter application, the corresponding values were 7.22±0.70 cm, 5.61±0.31 cm and 3.91±0.59 cm, respectively (p < 0.001). All three types of sheath rotated smoothly and enabled both the wires and catheters to be guided toward the pylorus of the dog in all cases. Conclusion The newly designed sheaths can be useful for gastroduodenal intervention.
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Affiliation(s)
- Tae-Seok Seo
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Abstract
BACKGROUND AND AIM Endoscopic balloon dilatation (EBD) has been used for the treatment of gastric outlet obstruction (GOO). There are several reports on the utility and success of this non-surgical treatment option in peptic GOO, with variable results. However, there are only a few reports documenting the efficacy of this method for non-peptic GOO. The authors here report on experience with balloon dilatation in peptic and non-peptic GOO over a 3-year period. METHODS Twenty-three patients with benign GOO underwent EBD. Dilatation was carried out with through-the-scope balloon dilators after premedication. Dilatation was repeated every week and the response was documented on the basis of symptoms and endoscopic findings and barium studies. Helicobacter pylori was eradicated in patients with peptic GOO, when present. RESULTS The 23 patients with GOO included 11 with peptic ulcer as the etiology, eight with corrosive-induced and four with chronic pancreatitis (alcohol three, idiopathic one). Patients with peptic GOO required 1-3 sessions (mean 2.0 +/- 0.63) to achieve a diameter of 15 mm dilatation, with uniformly good response over a mean follow-up period of 14.04 +/- 9.79 months. Corrosive-induced GOO required a larger number of dilatation sessions (2-9, mean 5.63 +/- 2.88), but the response was equally good, with follow up of 12-30 months. Patients with pancreatitis-related GOO, however, failed to respond despite a mean of 5.50 (+/-0.58) dilatations, and continued to have symptoms. All these patients were subjected to surgical bypass. There were no major complications such as perforation. CONCLUSIONS A good response can be expected in the majority of patients with peptic and corrosive-related GOO after balloon dilatation; however, poor results are noted for chronic pancreatitis-related GOO.
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Affiliation(s)
- Rakesh Kochhar
- Clinical section, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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el-Shabrawi A, Cerwenka H, Bacher H, Schweiger J, Kornprat P, Mischinger HJ. Endoskopische Palliation der malignen Magenausgangsstenose durch selbstexpandierbare Metallstents. Wien Klin Wochenschr 2003; 115:840-5. [PMID: 14740348 DOI: 10.1007/bf03041045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Malignant gastric outlet stenosis is caused by tumour obstruction and restricts the oral intake of food, resulting in a seriously reduced quality of life. Endoscopic implantation of self expanding metal stents (SEMS) can clear stenosis in the GI-tract and reestablish and preserve the passage in the GI-tract. PATIENTS AND METHODS Between October 2001 and April 2003 seven patients with malignant gastric outlet stenosis have been treated by the implantation of SEMS. Four patients had malignant stenosis in the upper duodenum or gastric antrum, two patients had stenosis because of tumour recurrence in the efferent loop of the jejunum after gastric resection because of gastric carcinoma and one patient had an obstruction 20 cm distal of the oesophagus after gastrectomy because of gastric cancer. RESULTS In all patients obstruction was cleared by the implantation of SEMS, and oral intake of food was possible in all patients after two days. No serious complications occurred during or after stent implantation. CONCLUSION Stent implantation for the treatment of malignant gastric outlet stenosis is a cost effective procedure, associated with low risk and low stress for the patient, and provides excellent palliation of symptoms in patients with malignant gastric outlet stenosis.
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Affiliation(s)
- Azab el-Shabrawi
- Klinische Abteilung für Allgemeinchirurgie, Universitätsklinik für Chirurgie, Graz, Osterreich.
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19
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Giménez Vaillo F, Cano Cuenca B, Pardo Mateu L, Pérez Climent F, Monzó Gandía R. [Balloon catheter dilatation in pharyngo-esophageal stenosis]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2002; 53:353-8. [PMID: 12185870 DOI: 10.1016/s0001-6519(02)78320-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
On the scarring strictures at the level of the pharyngo-esophageal junction, for example following surgery for pharyngo-laryngeal tumours, the treatment was traditionally the use of transoral dilators, as the metallic spark plugs or olives. At present the balloon catheters are the election technique for all cases. The advantages for the balloon catheters versus the traditional methods are the smaller morbidity and mortality, the effectiveness, simplicity and little cost. We show the protocol done in our center for the dilation of these strictures.
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20
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Vance PL, de Lange EE, Shaffer HA, Schirmer B. Gastric outlet obstruction following surgery for morbid obesity: efficacy of fluoroscopically guided balloon dilation. Radiology 2002; 222:70-2. [PMID: 11756707 DOI: 10.1148/radiol.2221010640] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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.
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Affiliation(s)
- Peter L Vance
- Department of Radiology, University of Virginia Health System, Lee St, HSC 800170, Charlottesville, VA 22908, USA.
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21
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Watson GMT, Grundy A. Non‐vascular hollow organ gastrointestinal intervention. IMAGING 2000. [DOI: 10.1259/img.12.3.120209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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22
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Goodacre BW, Esch OE, Vansonnenberg E, Pencil S, D'agostino HB, Sanchez RS. Large bore transhepatic tract dilatation in pigs: Results and implications for human procedures. MINIM INVASIV THER 1999. [DOI: 10.3109/13645709909153125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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23
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Sheikh R, Trudeau W. Gastric outlet obstruction caused by microperforation of Helicobacter pylori-related antral ulcer. J Clin Gastroenterol 1998; 26:141-3. [PMID: 9563927 DOI: 10.1097/00004836-199803000-00011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We report a Helicobacter pylori-related antral gastric ulcer that continued to cause symptoms despite H. pylori eradication. The patient had progressive gastric outlet obstruction, raising the possibility of a malignancy. On exploratory laparotomy, he was found to have a large inflammatory mass surrounding a contained microperforation.
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Affiliation(s)
- R Sheikh
- Division of Gastroenterology, University of California Davis Medical Center, Sacramento 95817, USA
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24
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Towbin R. Pediatric Gastrointestinal Interventions. J Vasc Interv Radiol 1998. [DOI: 10.1016/s1051-0443(98)70062-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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25
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Abstract
Acquired gastric outlet obstruction is more commonly owing to malignancy than ulcer disease. Endoscopy is the preferred method for diagnosis. Surgical palliation for malignant disease has poor results and high rates of morbidity and mortality. Initial experiences with endoscopic palliation with expandable metallic endoprostheses appear promising. Peptic ulcer-induced gastric outlet obstruction can be treated safely with endoscopic balloon dilation. About 65% of patients have sustained symptom relief, but many require more than one dilation session. Outcomes may be improved with effective ulcer therapy with acid reduction and eradication of H. pylori. Surgery is associated with significant morbidity and mortality and should be reserved for endoscopic treatment failures.
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Affiliation(s)
- S K Khullar
- Division of Gastroenterology, University of Utah School of Medicine and Health Sciences Center, Salt Lake City, USA
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26
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Azarow K, Kim P, Shandling B, Ein S. A 45-year experience with surgical treatment of peptic ulcer disease in children. J Pediatr Surg 1996; 31:750-3. [PMID: 8783092 DOI: 10.1016/s0022-3468(96)90122-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Peptic ulcer disease (PUD) requiring surgical treatment has become rare with the availability of modern medical management. A retrospective study of all patients who required operations for PUD between 1949 and 1994 (n = 43) was done. The patients were classified into 3 groups: A (n = 38): pre-histamine-2 (H2) blocker era (1949-1975); B (n = 3): pre-hydrogen-potassium (H-K+) ATPase inhibitor era (1976-1988); C (n = 2): H-K+ ATPase inhibitor era (1989-1994). Data, analyzed using X2 analysis (P < .01), included preoperative medical therapy, surgical indications, type of operation performed, complications, and postoperative medical therapy. The indication for surgery in group A was bleeding (26), perforation (8), or obstruction (4); in group B the indication was obstruction (2) or perforation (1); in group C the indication was obstruction (1) or bleeding (1). The incidence of obstruction as an indication for surgery did not differ among the groups (P < .01). Two of the three patients who had surgery for obstruction in groups B and C had biopsy-proven Helicobacter pylori. The postoperative morbidity rate was lower for groups B and C, although not significantly. The relative mortality among the groups did not change (P > .01). Children with PUD can have complications similar to those of adults with PUD. Since the introduction of H2 antagonists, the recognition and treatment of H pylori, and the use of H-K+ ATPase inhibition, the incidence of operations for bleeding and perforation has decreased dramatically. However, the incidence of surgery for obstruction remains the same.
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Affiliation(s)
- K Azarow
- Division of General Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
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27
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Lau JY, Chung SC, Sung JJ, Chan AC, Ng EK, Suen RC, Li AK. Through-the-scope balloon dilation for pyloric stenosis: long-term results. Gastrointest Endosc 1996; 43:98-101. [PMID: 8635729 DOI: 10.1016/s0016-5107(06)80107-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Through-the-scope balloon dilation has been used for treatment of benign pyloric stenosis; however, long-term results are lacking in the literature. METHOD A retrospective analysis using the Kaplan-Meier method. RESULTS Between November 1986 and December 1993, 54 patients underwent through-the-scope balloon dilations for pyloric stenosis. The mean age was 57.5 years. There were 5 (9.3%) initial treatment failures due to tight stenoses and perforations from dilation occurred in 4(7.4%) patients. Forty-five (83.3%) patients underwent successful dilation. Four patients developed rapid restenoses and were found to have malignant obstructions. Forty-one patients entered our study. Time at risk commenced on the date of initial dilation. The end point was defined at the time at which patients presented with recurrent obstruction or other ulcer complications. The median follow-up period was 39 months. The ulcer complication-free probability at 3 months, and at 1, 2, and 3 years was 79.1%, 73.4%, 69.3%, and 54.7%, respectively. In all, 21 (51.2%) patients required subsequent surgery: 18 for recurrent obstructions, 2 for interval perforations, and 1 for bleeding. CONCLUSION While through-the-scope balloon dilation may palliate symptoms of obstruction, recurrent obstruction and other ulcer complications are common. It should be reserved only for patients at high risk for operative surgery.
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Affiliation(s)
- J Y Lau
- Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
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28
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29
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Couckuyt H, Gevers AM, Coremans G, Hiele M, Rutgeerts P. Efficacy and safety of hydrostatic balloon dilatation of ileocolonic Crohn's strictures: a prospective longterm analysis. Gut 1995; 36:577-80. [PMID: 7737567 PMCID: PMC1382500 DOI: 10.1136/gut.36.4.577] [Citation(s) in RCA: 171] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Preliminary reports have suggested that dilatation using hydrostatic through the scope balloons may be useful for the treatment of Crohn's strictures, A prospective longterm follow up (mean (SD) 33.6 (11.2) months) was carried out in 55 Crohn's patients with 59 ileocolonic strictures submitted to 78 dilatation procedures. Hydrostatic balloons were used (Rigiflator, Microvasive) with a diameter of 18 mm on inflation. As soon as the balloons became available dilatation up to a diameter of 20 and 25 mm was attempted. The dilatations were performed under general anaesthesia using propofol (Diprivan). The patients were kept for one night in the hospital after dilatation. Seventy (90%) procedures were technically successful and passage of the stricture with a 13.6 mm diameter colonoscope was possible after 73% of the dilatations. Complications occurred in six patients (11%; 8% of procedures), including sealed perforations (n = 2), retroperitoneal perforations (n = 2), and intraperitoneal perforations (n = 2). Two of the patients were treated surgically with a one stage resection of the stricture and recovered uneventfully. Four patients were treated conservatively with intravenous fluids and antibiotics. There was no mortality. Dilatation completely relieved obstructive symptoms in 20 patients after one procedure, in another 14 patients after two (n = 13) or three (n = 1) dilatations. Total longterm success rate was 34 of 55 patients (62%). Nineteen patients (38%) were operated on because of persistent obstructive symptoms. The data show that endoscopic dilatation using the through the scope hydrostatic balloon system relieves obstructive symptoms resulting from ileocolonic Crohn's strictures. The procedure, however, carries a definite risk of perforation.
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Affiliation(s)
- H Couckuyt
- Department of Internal Medicine, University Hospital Gasthuisberg, University of Leuven, Belgium
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30
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Abstract
Although the immediate success of endoscopic balloon dilation of nonmalignant and noncongenital pyloric stenosis is known, little information is available on the long-term results of such therapy. Of 19 patients who underwent this treatment at our institution for gastric outlet obstruction, 3 (16%) experienced sustained relief and 16 (84%) had a recurrence of symptoms during a median follow-up period of 45 months. Twelve of the patients who had a recurrence of gastric outlet obstructive symptoms required further therapy. Our results suggest that if followed for a prolonged period of time, patients who have undergone endoscopic balloon dilation of nonmalignant pyloric stenosis have a high recurrence rate of symptomatic gastric outlet obstruction.
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Affiliation(s)
- S K Kuwada
- Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota 55905, USA
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31
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Shaffer HA, de Lange EE. Gastrointestinal foreign bodies and strictures: radiologic interventions. Curr Probl Diagn Radiol 1994; 23:205-49. [PMID: 7867376 DOI: 10.1016/0363-0188(94)90015-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Food impaction and foreign body ingestion are significant and sometimes life-threatening medical problems. As described in part 1 of this monograph, a variety of techniques and instruments are available to diagnose and treat these conditions. The radiologist interested in interventional procedures can find ample opportunities to participate in the management of esophageal obstructions by applying radiographic and fluoroscopic techniques to the diagnosis and removal of foreign bodies and food impactions. The recommended radiologic procedures are relatively safe, cost-effective, and efficient methods of addressing these serious situations. Stricture formation in the gastrointestinal tract is another significant medical problem that can often be managed nonoperatively by the radiologist. Fluoroscopically guided balloon dilatation has become an accepted method of effectively treating a large variety of strictures. As described in part 2 of this article, the technique is easy to perform, usually with very little inconvenience to the patient, and the risks of complications are very low. The procedure is relatively inexpensive and does not require the acquisition of any specialized or high-technology equipment. Also, the technique can be performed easily by any radiologist with interest in interventional procedures on the gut. A wide use of the fluoroscopic methods for treatment of impacted foreign bodies and strictures of the gastrointestinal tract is recommended.
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Affiliation(s)
- H A Shaffer
- Department of Radiology, University of Virginia, Charlottesville
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32
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Jaeger H, Mathias K. Esophageal calcification after corrosive injury. ABDOMINAL IMAGING 1994; 19:293-4. [PMID: 8075546 DOI: 10.1007/bf00198180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A clinically silent case of intramural esophageal calcification secondary to corrosive injury is presented. Computed tomography (CT) demonstrated a circular calcified esophageal wall over a distance of 5 cm leaving a residual esophageal lumen of 5 mm.
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Affiliation(s)
- H Jaeger
- Department of Diagnostic Radiology, Teaching Hospital Dortmund, Germany
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33
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Peer A, Klin B, Vinograd I. Balloon catheter dilatation of focal colonic strictures following necrotizing enterocolitis. Cardiovasc Intervent Radiol 1993; 16:248-50. [PMID: 8402790 DOI: 10.1007/bf02602971] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Two infants with severe colonic strictures secondary to necrotizing enterocolitis (NEC) were successfully dilated with balloon catheters. The procedures were performed under mild sedation, with fluoroscopic guidance. Results were sustained for more than 4 years follow-up. This procedure proved to be a safe and effective alternative to operative repair.
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Affiliation(s)
- A Peer
- Department of Radiology, Assaf Harofeh Medical Center, Sackler School of Medicine, Tel-Aviv University, Israel
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34
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Abstract
Balloon dilatation has become a widely accepted technique in the management of oesophageal and other gastrointestinal strictures. The use of this procedure in the pharynx has rarely been reported. We have performed 55 balloon dilatations on 13 patients with pharyngeal strictures. In three patients all symptoms were permanently abolished after one dilatation. Seven patients were successfully managed with repeated, regular dilatations. Two patients had a good initial response but this was not maintained and one patient had no relief of symptoms. Balloon dilatation is minimally invasive, less traumatic than rigid pharyngoscopy with dilatation, and well tolerated. It may be frequently repeated, and has successfully relieved dysphagia caused by benign and malignant strictures of the pharynx, including instances where previous rigid bouginage had failed.
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Affiliation(s)
- J M Rowe-Jones
- Department of Otolaryngology, St. George's Hospital and Medical School, London, UK
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35
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Iwasaki T, Hayashi N, Kimoto T, Murashima S, Nakashima T, Odori T, Ishii Y, Noriki S, Yoshioka T, Uchida H. Application of a self-expanding metallic stent to a strictured esophagojejunostomy. Cardiovasc Intervent Radiol 1993; 16:98-101. [PMID: 8485752 DOI: 10.1007/bf02602987] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We placed a Gianturco self-expanding metallic stent across the recurrent stricture of an esophagojejunostomy in a patient with gastric cancer. Though excellent passage of food resulted, intractable reflux occurred. Two months later the patient succumbed to recurrent tumor. At autopsy, the stent was patent and was partially covered by esophageal mucosa. There were narrow but deep ulcers around the stent hooks. The Gianturco metallic stent may provide an additional option for treating recurrent enteric strictures after other methods fail. Further refinements of the technique appear necessary.
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Affiliation(s)
- T Iwasaki
- Department of Radiology, Fukui Medical School, Japan
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36
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Grundy A. The radiological management of gastrointestinal strictures and other obstructive lesions. BAILLIERE'S CLINICAL GASTROENTEROLOGY 1992; 6:319-40. [PMID: 1392093 DOI: 10.1016/0950-3528(92)90007-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Balloon dilation of gastrointestinal strictures using a radiologic, endoscopic or combined approach is a safe, effective means of managing an ever-increasing variety of stricturing processes. At present the ability to dilate strictures in the gastrointestinal tract is limited mainly by access. Balloon dilation is now well established in the management of oesophageal and anastomotic lesions. The place of balloon dilation in the management of Crohn's disease and in the management of malignant disease requires further evaluation.
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37
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Breysem Y, Janssens JF, Coremans G, Vantrappen G, Hendrickx G, Rutgeerts P. Endoscopic balloon dilation of colonic and ileo-colonic Crohn's strictures: long-term results. Gastrointest Endosc 1992; 38:142-7. [PMID: 1568610 DOI: 10.1016/s0016-5107(92)70379-4] [Citation(s) in RCA: 86] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The long-term effects of endoscopic dilation of colonic or ileo-colonic Crohn's disease strictures were analyzed. In 18 patients with a Crohn's disease-related low gastrointestinal stricture, the stenosis was dilated using through-the-scope (TTS) balloon catheters. A dilation to a diameter of 18 mm was always attempted. Treatment was successfully carried out in 16 patients, and was followed by immediate symptomatic relief in 14 patients. Long-term success was observed in nine patients. There were no complications. Balloon catheter dilation of a colonic stricture or stricture of an ileo-colonic anastomosis was found to be safe and effective. This treatment modality can be an alternative to surgery in a selected group of patients.
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Affiliation(s)
- Y Breysem
- Department of Internal Medicine, University Hospital Gasthuisberg, University of Leuven, Belgium
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38
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Roy S, Baijal SS, Phadke RV, Choudhuri G. Inadvertent duodenal stenting: a case report. AUSTRALASIAN RADIOLOGY 1992; 36:80-2. [PMID: 1632759 DOI: 10.1111/j.1440-1673.1992.tb03085.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A Gianturco type metallic stent placed in the common bile duct migrated into the duodenum. The device remains in situ, and has caused no ill-effects to date. This raises the possibility that such stents may be deployed in the gastrointestinal tract.
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Affiliation(s)
- S Roy
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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39
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Campbell DM, Geraghty JG, McBride K, Murphy JJ, MacErlean D. Radiologically controlled balloon dilatation of rectal strictures. Clin Radiol 1991; 44:77-8. [PMID: 1884589 DOI: 10.1016/s0009-9260(05)80499-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Rectal stricture is a well recognized complication following anterior resection. It is traditionally managed with metal dilators or resection. This paper describes the use of balloon dilatation for benign anastomotic rectal strictures. Eight patients were included in the trial. Only one dilatation was necessary in four patients while the remaining four patients required further dilatation for relief of symptoms. The mean diameter of the stricture increased from 7.2 mm to 17.0 mm post-dilatation. There were no complications associated with the procedure. Balloon dilatation is a safe and effective method of treating benign anastomotic rectal strictures.
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Affiliation(s)
- D M Campbell
- Department of Surgery, St. Vincent's Hospital, Dublin, Ireland
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40
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Dakkak M, Bennett JR. Balloon technology and its applications in gastrointestinal endoscopy. BAILLIERE'S CLINICAL GASTROENTEROLOGY 1991; 5:195-208. [PMID: 1854987 DOI: 10.1016/0950-3528(91)90012-p] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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41
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Kozarek RA, Botoman VA, Patterson DJ. Long-term follow-up in patients who have undergone balloon dilation for gastric outlet obstruction. Gastrointest Endosc 1990; 36:558-61. [PMID: 2279642 DOI: 10.1016/s0016-5107(90)71163-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Although balloon dilation for gastric outlet obstruction has supplanted vagotomy plus drainage or resective therapy in some institutions, there are no long-term data which demonstrate what percentage of patients ultimately requires surgical intervention. Of 23 evaluable patients treated with hydrostatic balloon dilation in our institution, 70% were asymptomatic at a mean follow-up of 2.5 years. Five patients required surgery--one for acute perforation and the other four for symptoms of continued obstruction, despite one to three additional attempts at dilation. Only three of seven patients with previous gastric resection had a satisfactory long-term result. Whereas endoscopic therapy initially cost one tenth to one fifth that of surgical intervention, such figures do not factor for loss of productivity, on the one hand, or potential need for chronic H2 blockade, on the other. Despite instruction to the contrary, only 6 of 15 (40%) active patients continue acid-suppressive therapy. We conclude that balloon dilation remains a viable alternative for selected patients with gastric outlet obstruction.
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Affiliation(s)
- R A Kozarek
- Section of Gastroenterology, Virginia Mason Clinic, Seattle, Washington 98111
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42
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Affiliation(s)
- G K McLean
- Department of Radiology, Western Pennsylvania Hospital, Pittsburgh
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43
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Abstract
Balloon esophageal dilation was performed in 74 patients, 60 of whom had malignant neoplasia of the esophagus, 11 had benign esophageal stenoses, and 3 had esophageal stenoses caused by nonesophageal cancer. Sixteen patients underwent preoperative balloon dilations and 15 were able to swallow until surgery. In 49 patients receiving palliative treatment for esophageal cancer, balloon dilatation allowed 40 (82%) to swallow until near death. We experienced one esophageal rupture.
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Affiliation(s)
- J Nóbrega
- Instituto Portugues de Oncologia, Centro Do Norte, Porto
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44
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Lambert M, Faintuch JS. Laser recanalization of pyloric stenosis: a guidewire-directed contact probe technique. Lasers Surg Med 1989; 9:282-5. [PMID: 2733537 DOI: 10.1002/lsm.1900090312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A variety of techniques has been used to relieve the obstructive symptoms of pyloric stenosis. Endoscopic dilatation using hydrostatic balloon dilators, multiple-diameter bougies, and electrocautery with a sphincterotome have been described. The neodymium yttrium aluminum garnet laser also has been used, with both noncontact and contact probes. We describe a new technique using a guidewire-directed contact probe for laser recanalization of pyloric stenosis in a patient with radiation-induced gastric outlet obstruction.
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Affiliation(s)
- M Lambert
- Department of Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston 77030
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45
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Hawkins DB. Dilation of esophageal strictures: comparative morbidity of antegrade and retrograde methods. Ann Otol Rhinol Laryngol 1988; 97:460-5. [PMID: 3052221 DOI: 10.1177/000348948809700505] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A total of 687 dilations of esophageal strictures were performed on 59 patients in the operating room over a 17-year period. Seventy-nine percent of the strictures were secondary to caustic ingestion and 89% of the dilations were in these patients. Antegrade dilations were performed 389 times and retrograde dilations were performed 298 times. Esophageal perforation occurred seven times with antegrade dilations. There were no perforations with retrograde dilations. The retrograde method using Tucker bougies is the safest and most successful method of dilating severe strictures.
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Affiliation(s)
- D B Hawkins
- Department of Otolaryngology-Head and Neck Surgery, Los Angeles County-University of Southern California Medical Center
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