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Fluoroscopically guided balloon dilation for benign anastomotic stricture in the upper gastrointestinal tract.

Kim JH, Shin JH, Song HY - Korean J Radiol (2008 Jul-Aug)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

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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Fluoroscopically guided balloon dilation for anastomotic stricture at gastroduodenostomy.A. UGI series before balloon dilation shows anastomotic stricture (arrow) at gastroduodenostomy.B-E. Anastomotic stricture is initially dilated using 15-mm-diameter balloon. As dilation is easily accomplished, caliber of balloon catheter is increased to 20 mm.F, G. UGI series immediately (F) and one month after (G) balloon dilation showed improvement of luminal diameter (arrows).
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Figure 1: Fluoroscopically guided balloon dilation for anastomotic stricture at gastroduodenostomy.A. UGI series before balloon dilation shows anastomotic stricture (arrow) at gastroduodenostomy.B-E. Anastomotic stricture is initially dilated using 15-mm-diameter balloon. As dilation is easily accomplished, caliber of balloon catheter is increased to 20 mm.F, G. UGI series immediately (F) and one month after (G) balloon dilation showed improvement of luminal diameter (arrows).

Mentions: Dilations should be performed with increasing balloon diameters starting with small balloons and progressing to larger sizes in order to minimize the rate of perforation. To prevent recurrent symptoms and allow for the fewest complications, 20-25 mm is recommended as the optimal maximum balloon diameter (1, 2, 6, 8). Most often, a 10-15 mm diameter balloon is initially used. If dilation with a 10-15 mm balloon is easily accomplished and the patient tolerates the procedure well, the caliber of the balloon catheter is increased up to 20-25 mm (Fig. 1). If at any point the patient complains of intolerable pain, or if a persistent waist remains in the balloon despite a maximal inflation pressure (i.e., 6 atm), the dilation should be discontinued (10). In pediatric patients with anastomotic strictures after surgical repair of esophageal atresia (3, 14), the first dilation is usually made with a balloon 4-8 mm in diameter. If dilation is easily accomplished, the size of the balloon is gradually increased by the use of 2-mm steps during the same session.


Fluoroscopically guided balloon dilation for benign anastomotic stricture in the upper gastrointestinal tract.

Kim JH, Shin JH, Song HY - Korean J Radiol (2008 Jul-Aug)

Fluoroscopically guided balloon dilation for anastomotic stricture at gastroduodenostomy.A. UGI series before balloon dilation shows anastomotic stricture (arrow) at gastroduodenostomy.B-E. Anastomotic stricture is initially dilated using 15-mm-diameter balloon. As dilation is easily accomplished, caliber of balloon catheter is increased to 20 mm.F, G. UGI series immediately (F) and one month after (G) balloon dilation showed improvement of luminal diameter (arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627276&req=5

Figure 1: Fluoroscopically guided balloon dilation for anastomotic stricture at gastroduodenostomy.A. UGI series before balloon dilation shows anastomotic stricture (arrow) at gastroduodenostomy.B-E. Anastomotic stricture is initially dilated using 15-mm-diameter balloon. As dilation is easily accomplished, caliber of balloon catheter is increased to 20 mm.F, G. UGI series immediately (F) and one month after (G) balloon dilation showed improvement of luminal diameter (arrows).
Mentions: Dilations should be performed with increasing balloon diameters starting with small balloons and progressing to larger sizes in order to minimize the rate of perforation. To prevent recurrent symptoms and allow for the fewest complications, 20-25 mm is recommended as the optimal maximum balloon diameter (1, 2, 6, 8). Most often, a 10-15 mm diameter balloon is initially used. If dilation with a 10-15 mm balloon is easily accomplished and the patient tolerates the procedure well, the caliber of the balloon catheter is increased up to 20-25 mm (Fig. 1). If at any point the patient complains of intolerable pain, or if a persistent waist remains in the balloon despite a maximal inflation pressure (i.e., 6 atm), the dilation should be discontinued (10). In pediatric patients with anastomotic strictures after surgical repair of esophageal atresia (3, 14), the first dilation is usually made with a balloon 4-8 mm in diameter. If dilation is easily accomplished, the size of the balloon is gradually increased by the use of 2-mm steps during the same session.

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

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.

Show MeSH
Related in: MedlinePlus