Balloon Dilatation of Small-Intestinal Benign Strictures Using Double-Balloon Endoscopy

Abstract

Background: Endoscopic balloon dilatation has proven to be an effective and safe procedure for benign colonic strictures. We developed double-balloon endoscopy (DBE), a novel technique capable of accessing entire small intestine. Small-intestinal strictures can be reached and dilated endoscopically using DBE. Purpose: This study evaluated clinical outcomes of the balloon dilatation therapies in patients with benign small-intestinal strictures. Patients: For 197 patients, 298 DBE examinations were performed between Sep. 2000 and Oct. 2004 at Jichi medical school hospital, Tochigi, Japan, and 9 patients had undergone balloon dilatation therapies for benign small-intestinal strictures. The average age of the 9 patients was 49.1 (30-89); 3 men and 6 women; Crohn's disease (3 patients), NSAIDs enteritis (1 patient), post-traumatic stricture (1 patient), post-incarcerated inguinal hernia stricture (1 patient), non-specific multiple ulcers of the small intestine (1 patient), and strictures of unknown etiology (2 patients). Methods: Endoscopic access and direct observation of the strictures were achieved in all 9 patients by using DBE. Biopsy was taken endoscopically from the strictures to rule out malignancy. Sequentially expandable balloon catheters, in which diameter of the balloon can be increased or decreased by controlling the pressure of the balloon, were selected and used. The balloon of the catheter was placed across the stricture with the help of a guide wire under fluoroscopic guidance. Dilation procedures were done under conscious sedation to monitor patients' discomfort in order to avoid perforation during dilatation. Results: Strictures were located in the jejunum in 4 cases, in the mid small bowel in 3 cases and in the ileum in 2 cases. Endoscopic balloon dilatation was successful in all patients with the 1 to 5 times of dilatation in each patient. The maximum diameter of dilatation in one session ranged from 10 to 20 mm. Passage of the DBE through the lesion after the dilatation was possible in 8 of 9 patients. Neither bleeding nor perforation was observed. 3 patients with Crohn's disease were asymptomatic and surgery-free for the follow-up of 12 months on the average. Conclusion: Balloon dilatation is an attractive first-line therapy for the benign strictures in the small bowel because it is minimally invasive, safe, and effective.