Fluoroscopically Guided Balloon Dilation of the Esophagus

 

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Balloon dilation has become a common method for treating a variety of esophageal conditions. When properly performed, it is an effective procedure with a high rate of success. Fluoroscopically guided balloon dilation offers distinct advantages over endoscopically performed balloon dilation or blindly performed bougienage, as it allows for better visual control of the procedure and morbidity is low. In our experience, fluoroscopically guided esophageal balloon dilation is safe and easy to perform, provided that the operators are aware of the potential complications and the procedure is properly tailored to the patient's underlying condition.

At our institution, over the course of 25 years we have performed more than 2300 fluoroscopically guided esophageal balloon dilations to treat a multitude of disorders including strictures of benign and malignant etiology, anastomotic strictures, radiation-induced strictures, tight gastric fundoplication wraps, esophageal webs and rings, achalasia, and anastomotic leaks. Over the years that we have performed the procedure, we have adapted our technique to maximize postprocedural outcomes and utilize available technology. In this article, we describe our current technique, present the various conditions amenable to balloon dilation, and emphasize modifications for each condition. We also discuss potential problems and complications that we have experienced in our practice.

REFERENCES

• 1 Baron T H. Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract.  N Engl J Med. 2001;  344 1681-1687
  CrossrefPubMedGoogle Scholar
• 2 Kadakia S C, Wong R K. Graded pneumatic dilation using Rigiflex achalasia dilators in patients with primary esophageal achalasia.  Am J Gastroenterol. 1993;  88 34-38
  PubMedGoogle Scholar
• 3 Wong R K. Pneumatic dilation for achalasia.  Am J Gastroenterol. 2004;  99 578-580
  CrossrefPubMedGoogle Scholar
• 4 Zerbib F, Thétiot V, Richy F, Benajah D A, Message L, Lamouliatte H. Repeated pneumatic dilations as long-term maintenance therapy for esophageal achalasia.  Am J Gastroenterol. 2006;  101 692-697
  CrossrefPubMedGoogle Scholar
• 5 Mikaeli J, Bishehsari F, Montazeri G, Yaghoobi M, Malekzadeh R. Pneumatic balloon dilatation in achalasia: a prospective comparison of safety and efficacy with different balloon diameters.  Aliment Pharmacol Ther. 2004;  20 431-436
  CrossrefPubMedGoogle Scholar
• 6 Huynh P T, de Lange E E, Shaffer Jr H A. Symptomatic webs of the upper esophagus: treatment with fluoroscopically guided balloon dilation.  Radiology. 1995;  196 789-792
  PubMedGoogle Scholar
• 7 Funch-Jensen P, Jacobsen B. Dysphagia after laparoscopic Nissen fundoplication.  Scand J Gastroenterol. 2007;  42 428-431
  CrossrefPubMedGoogle Scholar
• 8 Orringer M B, Orringer J S. Esophagectomy: definitive treatment for esophageal neuromotor dysfunction.  Ann Thorac Surg. 1982;  34 237-248
  CrossrefPubMedGoogle Scholar
• 9 Orringer M B, Sloan H. Esophagectomy without thoracotomy.  J Thorac Cardiovasc Surg. 1978;  76 643-654
  PubMedGoogle Scholar
• 10 de Lange E E, Shaffer Jr H A, Holt P D. Esophagoenteric anastomotic leaks: treatment with fluoroscopically guided balloon dilatation.  AJR Am J Roentgenol. 1994;  162 51-54
  PubMedGoogle Scholar
• 11 Weintraub J L, Eubig J. Balloon catheter dilatation of benign esophageal strictures in children.  J Vasc Interv Radiol. 2006;  17 831-835
  CrossrefPubMedGoogle Scholar
• 12 Said M, Mekki M, Golli M et al.. Balloon dilatation of anastomotic strictures secondary to surgical repair of oesophageal atresia.  Br J Radiol. 2003;  76 26-31
  CrossrefPubMedGoogle Scholar
• 13 Azizkhan R G, Stehr W, Cohen A P et al.. Esophageal strictures in children with recessive dystrophic epidermolysis bullosa: an 11-year experience with fluoroscopically guided balloon dilatation.  J Pediatr Surg. 2006;  41 55-60 discussion 55-60
  CrossrefPubMedGoogle Scholar
• 14 Piotet E, Escher A, Monnier P. Esophageal and pharyngeal strictures: report on 1,862 endoscopic dilatations using the Savary-Gilliard technique.  Eur Arch Otorhinolaryngol. 2008;  265 357-364
  CrossrefPubMedGoogle Scholar
• 15 Adamek H E, Jakobs R, Dorlars D, Martin W R, Krömer M U, Riemann J F. Management of esophageal perforations after therapeutic upper gastrointestinal endoscopy.  Scand J Gastroenterol. 1997;  32 411-414
  CrossrefPubMedGoogle Scholar
• 16 Fry L C, Mönkemüller K, Neumann H, Schulz H U, Malfertheiner P. Incidence, clinical management and outcomes of esophageal perforations after endoscopic dilatation.  Z Gastroenterol. 2007;  45 1180-1184
  Article in Thieme ConnectPubMedGoogle Scholar
• 17 Drábek J, Keil R, Námesný I. The endoscopic treatment of benign esophageal strictures by balloon dilatation.  Dis Esophagus. 1999;  12 28-29
  CrossrefPubMedGoogle Scholar
• 18 Chan K C, Wong S K, Lee D W et al.. Short-term and long-term results of endoscopic balloon dilation for achalasia: 12 years' experience.  Endoscopy. 2004;  36 690-694
  Article in Thieme ConnectPubMedGoogle Scholar
• 19 Shaffer Jr H A, Valenzuela G, Mittal R K. Esophageal perforation. A reassessment of the criteria for choosing medical or surgical therapy.  Arch Intern Med. 1992;  152 757-761
  CrossrefPubMedGoogle Scholar
• 20 Inagake M, Yamane T, Kitao Y et al.. Balloon dilatation for anastomotic stricture after upper gastro-intestinal surgery.  World J Surg. 1992;  16 541-544
  CrossrefPubMedGoogle Scholar
• 21 de Lange E E, Shaffer Jr H A. Anastomotic strictures of the upper gastrointestinal tract: results of balloon dilation.  Radiology. 1988;  167 45-50
  PubMedGoogle Scholar
• 22 Whitworth P W, Richardson R L, Larson G M. Balloon dilatation of anastomotic strictures.  Arch Surg. 1988;  123 759-762
  PubMedGoogle Scholar
• 23 Lindor K D, Ott B J, Hughes Jr R W. Balloon dilatation of upper digestive tract strictures.  Gastroenterology. 1985;  89 545-548
  PubMedGoogle Scholar
• 24 Cho Y K, Shin J H, Kim B S et al.. Fluoroscopically guided balloon dilation of anastomotic strictures after total gastrectomy: long-term results.  AJR Am J Roentgenol. 2007;  188 647-651
  CrossrefPubMedGoogle Scholar

Eduard E de LangeM.D. 

Department of Radiology, University of Virginia, Box 800170

1000 Lee Street, Charlottesville, VA 22908

Email: delange@virginia.edu