Balloon Dilatation Of Anastomotic Strictures Research Articles

Incidents and risk factors of biliary complications after orthotropic liver transplantation.

Biliary complications (BC) especially stenosis and strictures are the most common complications after orthotropic liver transplantation (OLT) procedure in adult recipients. The intention of this study was analyzed BC in 273 patients after OLT for the last 4 years in our department.Retrospective study of 273 patients underwent cadaveric donor liver transplantation between January 2014 and December 2017. Most of them (n = 268) have anastomosed bile duct in end to end, rest of them (n = 5) underwent hepaticojejunostomy. Statistical analysis was performed using Fischer exact test and Student t test. A P value <.05 was considered significant.BC were developed in 48/273 transplants (17.6%). The most frequent was biliary stricture (n = 42, 87.5%) followed by bile leak (n = 4, 8.3%) and choledocholitiasis (n = 2, 4.2%). Treatment was usually using endoscopic retrograde cholangiopancreatography. Recipients with hypotension during and after OLT treated by norepinephrine have a higher index of BC.Self-expanding metal stents implantation seems to be more effective than repeated balloon dilatation of anastomotic strictures with subsequent plastic biliary stent placement and associated with similar complication rate. Good fluid management against inotropic therapy may reduce risk of BC.

Endoscopic retrograde cholangiography and percutaneous transhepatic cholangiodrainage in biliary strictures after liver transplantation: Long‐term outcome predictors and influence on patient survival

Biliary strictures are common complications after orthotopic liver transplantation. Endoscopic retrograde cholangiography evolved as standard and percutaneous transhepatic cholangiodrainage as alternative therapy. This study analysed predictors of long-term success of biliary strictures after endoscopic retrograde cholangiography and/or percutaneous transhepatic cholangiodrainage and its impact on patient survival. All adult patients with biliary strictures receiving endoscopic retrograde cholangiography and/or percutaneous transhepatic cholangiodrainage between 2009 and 2015 at the University Medical Center Hamburg-Eppendorf were retrospectively analysed. Potential predictors of long-term success (≥12months) were identified by univariate and logistic regression analyses. Patient survival was analysed by Kaplan-Meier method and log-rank test. Hundred and sixteen patients were treated with endoscopic retrograde cholangiography and/or percutaneous transhepatic cholangiodrainage, including 67 patients with anastomotic strictures, 22 with nonanastomotic strictures and 27 with both stricture types. Eighty-five patients received endoscopic retrograde cholangiography, 17 percutaneous transhepatic cholangiodrainage and 14 both techniques. Long-term success was achieved in 60 patients (52%). Predictors of treatment failure were a preinterventional C-reactive protein >8g/dL in anastomotic strictures (P=0.039) and a body mass index ≤21kg/m2 in nonanastomotic strictures (P=0.021). In patients who received endoscopic retrograde cholangiography only, balloon dilatation of anastomotic strictures with larger diameters favoured success (P=0.015). Achievement of long-term success was associated with prolonged patient survival in anastomotic strictures (P=0.036) and nonanastomotic strictures (P=0.025), but not in combined strictures (P=0.739). In post-orthotopic liver transplantation biliary strictures treated by endoscopic retrograde cholangiography and/or percutaneous transhepatic cholangiodrainage, patient BMI and preinterventional C-reactive protein may influence prognosis. Endoscopic retrograde cholangiography with larger balloon diameter may favour success in anastomotic strictures. Long-term success by endoscopic retrograde cholangiography and/or percutaneous transhepatic cholangiodrainage is associated with superior survival in patients with anastomotic strictures and nonanastomotic strictures only.

Application and nursing care of persistent balloon dilatation for anastomotic stricture after choledochojejunostomy

Objective To investigate the value and nursing of persistent balloon dilatation for anastomotic stricture after choledochojejunostomy. Methods The clinical data of 14 cases of anastomotic strictures after choledochojejunostomy accepted the treatment of persistent balloon dilatation were analyzed retrospectively. The effect, adverse reactions and approriate nursing were evaluated. Results Five patients were performed with persistent balloon dilatation thorough the output loop of intestine after choledochojejunostomy and 9 patients through percutaneous transhepatic cholangiography. There was no hemobilia, bile leak or other serious complications. There were 2 cases of balloon dilatation catheter damage, 5 cases of pressure pump damage and 4 cases of balloon migration with 25.0% (7/28) instrument damage rate and 4 cases of balloon migration. After persistent balloon dilation for 6 to 8 months, no anastomotic stricture was found by choledochoscopic examination. Follow up for 6 to 18 months, 2 cases had recurrent anastomotic stricture. Conclusions Persistent balloon dilatation by percutaneous transhepatic cholangiography is a simple, safe and effective method for anastomotic stricture after choledochojejunostomy. In the course of nursing, the balloon catheter and pressure pump damage, and balloon migration should be noted. Key words: Nursing care; Anastomotic stricture; Choledochojejunostomy; Percutaneous transhepatic cholangiography; Balloon dilatation catheter

A Rare Cause of Chronic Post-prandial and Recumbent Cough: Gastro-pulmonary Fistula Post Oesophagectomy

We present a case of 75 years old male who underwent oesophagectomy for T3N2 adenocarcinoma. He developed post-op anastomotic leak requiring further surgery and subsequent covered oesophageal stent insertion, which was removed 4 months later. He required multiple OGDs and balloon dilatation for anastomotic stricture. 8 months post-op, an OGD showed non-malignant peptic ulceration of upper stomach. This healed subsequently. He then developed recumbent cough and was treated with multiple courses of antibiotics for x-ray proven right basal pneumonia. He improved clinically, however he continued to have cough which particularly comes when he lies down or after his meals. Repeat OGD showed a rare appearance of a gastro-pulmonary fistula as a cause for his symptoms. This was confirmed on CT. The biopsies were negative for malignancy. He was discussed in MDT and was seen by upper GI surgeons who are managing him conservatively due to his comorbidities. Our patient presented with 2 month history of cough after meals and on lying flat. He denied any significant reflux symptoms. He was given repeated courses of antibiotics by GP for chest infection which temporarily improved his symptoms. Past medical history includes myocardial infarction, protein C deficiency, recurrent DVTs and pulmonary emboli, IVC filter in situ. He was a non-smoker and drank alcohol only on occasions. His investigation consisted of, Blood tests showed mild leucocytosis, normocytic anaemia, raised CRP. CXR showed right basal consolidation. OGD showed fistulous connection between proximal stomach and lungs, the gastropulmonary fistula (Figure 1). A CT scan showed fistulous connection of stomach with right lung, right basal consolidation and effusion (Figure 2 & 3).Figure 1

Successful management of colonic perforation with a covered metal stent

Self-expandable stents are widely available for the treatment of perforation of the gastrointestinal tract. Because of the risk of migration, there has been no report of the use of self-expandable stents for the treatment of perforation of the colon or rectum. This is a report of successful treatment of iatrogenic colonic perforation during balloon dilatation of anastomotic stricture with a fully covered stent. Fully covered, self-expandable metallic stents can be considered useful tools for management of this condition.

Prolonged avoidance of repeat surgery with endoscopic balloon dilatation of anastomotic strictures in Crohn's disease

Background and aimsThere is a high rate of stricturing post-operative recurrence in Crohn's disease (CD) particularly at sites of surgical anastomosis, and over 50% of these patients will require a repeat resection. Endoscopic dilatation of anastomotic strictures is an alternative to surgical resection in selected patients. We aimed to evaluate the safety and long term efficacy of endoscopic balloon dilatation of symptomatic anastomotic strictures in CD. MethodsRetrospective analysis of a prospectively maintained inflammatory bowel disease database of patients attending a single academic centre (n=1244 patients with CD) who underwent dilatation. ResultsFifty-five dilatations were performed in 31 patients (mean age 43±SD 12, 47% female). Median follow‐up period was 46months (IQR 14–62). Ninety percent of patients had successful initial dilatation and no complications occurred. Six (21%) avoided further dilatations or surgery in the follow-up period. Stricture recurrence was detected in 22 patients; 15 (54%) patients had repeat dilatations and seven (25%) went straight to surgery. Eight (28%) patients were managed with repeat dilatations of the stricture (median dilatations=2 range 2–6) and seven (25%) required surgery despite repeat dilatations. Median time from first dilatation to repeat surgery was 14.5months (IQR 3–28) and to repeat dilatation was 13.8months (IQR 4–28). There was no difference in immunomodulator use, biologic use and smoking status between the groups requiring surgery versus dilatation only. ConclusionEndoscopic balloon dilatation of anastomotic strictures is safe and effective in providing symptomatic relief in CD patients. Forty-five percent of patients had a sustained response to single/serial balloon dilatation with avoidance of further surgical resection for a median interval of 46months. Post-operative medical therapy and smoking status did not predict requirement for recurrent dilatation or surgery.

Sa1908 Avoidance of Repeat Surgery With Endoscopic Balloon Dilatation of Anastomotic Strictures in Crohn's Disease

Sa1908 Avoidance of Repeat Surgery With Endoscopic Balloon Dilatation of Anastomotic Strictures in Crohn's Disease

P349 Risk of lymphoma in patients with inflammatory bowel disease: A Korean single-center study

P349 Risk of lymphoma in patients with inflammatory bowel disease: A Korean single-center study

P350 Long term outcome of endoscopic balloon dilatation of anastomotic strictures in patients with Crohn's disease

P350 Long term outcome of endoscopic balloon dilatation of anastomotic strictures in patients with Crohn's disease

Endoscopic Balloon Dilatation of Anastomotic Strictures in Patients With Crohn's Disease: Effect of Immediate Endoscopic Success and Biological Therapy

Endoscopic Balloon Dilatation of Anastomotic Strictures in Patients With Crohn's Disease: Effect of Immediate Endoscopic Success and Biological Therapy

Su1456 Therapeutic ERCP Using Short Double-Balloon Enteroscopy in Patients With Surgically Altered Anatomy

Su1456 Therapeutic ERCP Using Short Double-Balloon Enteroscopy in Patients With Surgically Altered Anatomy

Dual catheter placement technique for treatment of biliary anastomotic strictures after liver transplantation

The purpose of this study was to evaluate the results of percutaneous transhepatic management of anastomotic biliary strictures using the dual catheter placement technique (2 drainage catheters inserted via single percutaneous tract). The protocol of this retrospective study was approved by the institutional review board of our institution and written informed consent was waived. Percutaneous transhepatic biliary drainage and subsequent balloon dilation of anastomotic strictures were performed in 79 patients. Serial exchanges of drainage via catheter with larger diameters up to 14-French were performed at 1-month intervals followed by 3 exchanges of dual catheters at 2 month intervals. Drainage catheters were removed when follow-up cholangiography revealed improved strictures without recurrence of symptoms or elevation of biochemical findings. Technical success was achieved in all 79 (100%) patients after percutaneous transhepatic treatment. The mean period of dual catheter placement was 6.5 ± 1.1 months (range, 5.5-14.2 months). Clinical success was achieved in 78 (98.7%) of 79 patients and drainage catheters were removed 23.8 ± 8.8 months (range, 11.4-43.3 months) after the initial percutaneous transhepatic biliary drainage. Procedure-related complications occurred in 14 (17.8%) patients. During the mean follow-up period of 34.5 ± 3 months (range, 24.4-38.5 months) in the 78 patients, the primary patency rates were 96%, 92%, and 91% at 1, 2, and 3 years, respectively. Seven (9%) of the 78 patients experienced recurrent symptoms at a mean of 15.4 ± 8.9 months (range, 6.1-26.2 months) after catheter removal. In conclusion, the dual catheter placement technique seems to be an easy, safe, and effective method with an acceptable catheter intervention period for the treatment of anastomotic strictures following LDLT.

Effectiveness of Intralesional Triamcinolone Acetonide With Balloon Dilatation for Anastomotic Stricture in Postoperative Esophageal Atresia Patients

Effectiveness of Intralesional Triamcinolone Acetonide With Balloon Dilatation for Anastomotic Stricture in Postoperative Esophageal Atresia Patients

Anastomotic Strictures Following Esophageal Atresia Repair: A 20‐year Experience With Endoscopic Balloon Dilatation

The aim of the study was to evaluate the safety, effectiveness, and long-term results of endoscopic balloon dilatation in children with anastomotic strictures following esophageal atresia (EA) repair. From January 1988 to January 2008, 59 patients were treated with balloon dilatation for anastomotic stricture following EA repair. Indication for dilatation was dysphagia of varying degree. Outcome parameters included the number of dilatations, response to dilatation, effectiveness, and complications. Response to dilatation was considered excellent when there was no need for any additional dilatation for recurrent dysphagia, satisfactory when up to 5 dilatations were required, and fair when >5 sessions were required. The treatment was considered effective when dysphagia was grade 0 or 1 for >12 months after the last dilatation session. A total of 165 balloon dilatations were undertaken, with an average of 279 per patient (range 1-9). Age range at diagnosis was 1 to 36 months (mean 10.5). Response to dilatation was excellent in 21 cases (35.6%), satisfactory in 26 (44.1%), and fair in 12 (20.3%). The treatment was effective in 47 patients (79.7%) and ineffective in 12 (20.3%). The median follow-up period was 19.5 months. Four patients underwent surgery; in 1 patient a retrievable stent was placed. No perforation occurred. Endoscopic balloon dilatation can be accomplished safely and effectively as a first-line therapy for the management of anastomotic strictures following EA repair.

Endoscopic Balloon Dilation of Anastomotic Strictures Occurring after Laparoscopic Gastric Bypass for Morbid Obesity

Background: Gastrojejunal anastomotic stenosis of laparoscopic Roux-en-Y gastric bypass (LRYGB) for morbid obesity occurs in 3–25% of cases. The aim of this report was to evaluate the utility of endoscopic balloon dilation for the therapy of anastomotic strictures after LRYGB. Patients and Methods: 111 consecutive patients were treated with endoscopic dilation under sedation with propofol. Dilations were performed with through-the-scope over-the-wire balloons, with sizes ranging from 6 to 18 mm. The outcomes of the procedure were analyzed. Results: 200 endoscopic balloon dilations were performed in 111 patients. Repeated dilations were necessary in patients with complex stenosis. In 75% of the patients it was possible to dilate to 12 mm during the first session. Only in 2% of the cases was it impossible to introduce the endoscope through the stenosed anastomosis after dilation. On follow-up a repeat dilation was necessary in 26% of the cases. Minor complications occurred in 2.7% of patients (2 concealed perforations and 1 hematoma of the esophagus). These were treated conservatively. None of the patients required operation. Conclusions: Endoscopic balloon dilation is a safe and effective therapy for anastomotic strictures occurring after LRYGB.

Efficacy and Safety of Endoscopic Balloon Dilation of Benign Anastomotic Strictures After Oncologic Anterior Rectal Resection

Colorectal anastomotic benign strictures represent a challenging complication. Endoscopic dilation represents a valid and safe treatment. The purpose of this study is to retrospectively investigate the results of endoscopic balloon dilation for anastomotic stricture after anterior rectal resection for cancer in an institution. Twenty-four symptomatic patients with benign colorectal anastomotic stricture were treated between April 2001 and January 2005. All patients underwent dilation using through-the-scope balloon technique. The success of dilation, the number of sessions required, complications, recurrence, and the relationship between the number of dilation sessions and recurrence were assessed. Dilation was successful in 22 (91.7%) patients. There were no procedure-related complications. The mean number of sessions required was 2.3. There was no relationship between the number of dilation sessions and stricture recurrence. Through-the-scope dilation is effective and safe for benign colorectal anastomotic strictures after anterior resection. There was no relationship between the number of dilation sessions and recurrence.

Endoscopic Balloon Dilatation for Anastomotic Stricture Developed after Surgery for Colorectal Cancer

Purpose: This study was to evaluate the safety and efficacy of endoscopic balloon dilatation for anastomotic strictures that developed after colorectal cancer (CRC) operations. Methods: Between Jan. 2001 and Dec. 2006, 18 patients (12 men, 6 women) who underwent endoscopic balloon dilatation for anastomotic strictures that developed after CRC operation at the Center for Colorectal Cancer, National Cancer Center, were enrolled, and their medical records were reviewed retrospectively. The median distance from the anal verge to the stricture was 10 cm (range, 3~40 cm). Dilatations were performed using through-the-scope balloons with diameters of 18 to 20 mm on inflation. Results: The overall success rate of endoscopic balloon dilatation was 94.4% (17 patients). The mean number of treatment sessions per patient was 1.9 (range, 1~7). Of the 17 patients treated successfully, 11 patients (64.7%) required only one dilatation, 4 patients (23.2%) required 2 dilatations, and two patients (11.8%) required 7 dilatations. Failure of balloon dilatation occurred in one patient. No complications occurred. Conclusions: Endoscopic balloon dilatation of anastomotic strictures after a CRC operation is safe and efficient.

Long-term quality of life after endoscopic dilation of strictured colorectal or colocolonic anastomoses

Endoscopic balloon dilation is the first-line treatment for benign colorectal anastomotic strictures. We aimed to objectively assess its long-term results. Gastrointestinal symptoms and health-related quality of life (HRQoL) were assessed at long-term after balloon dilation of anastomotic strictures in 31 consecutive patients (excluding those with inflammatory bowel disease) as well as and controls, using the validated Gastrointestinal Quality of Life Index (GIQLI). Most colectomies had been performed for benign diseases, with anastomoses located at the colorectal junction. Completed surveys were collected from 81 subjects, including 27 study patients (response rate 87%), 27 surgical controls matched for age, gender, and indication of colectomy, and 27 healthy subjects. At a mean of 3.9 +/- 2.3 years after the first endoscopic balloon-dilation, study patients self-reported significantly more gastrointestinal symptoms than controls; these included frequent and urgent bowel movements, bloating, food restriction (p < or = 0.001, all comparisons), diarrhea, excessive passage of gas through the anus (p < 0.01, all comparisons), constipation, and abdominal pain (p < 0.05, all comparisons). Health-related quality of life was significantly impaired in study patients versus surgical controls and healthy subjects (GIQLI scores, 104 +/- 20, 119 +/- 24, and 121 +/- 16, respectively; p = 0.005). Impaired HRQoL subdimensions included gastrointestinal symptoms (p < 0.001), stress by treatment (p < 0.05), and emotional status (p = 0.08). HRQoL was independent of the delay between stricture dilation and the survey. Follow-up endoscopy (performed in 21/27 [78%] study patients, including the 7 patients with the lowest HRQoL, and 19 [70%] surgical controls) disclosed anastomoses larger than 13 mm in all cases. Health-related quality of life is significantly impaired at long-term after standard balloon-dilation of benign anastomotic colorectal strictures as a result of gastrointestinal symptoms and stress by treatment. This impairment might be related to the fact that an anastomotic diameter > or = 13 mm, although commonly used to define successful endoscopic treatment, is insufficient to provide long-term symptom relief in some patients, or to other, yet to be identified, factors.

Endoscopic Treatment of Anastomotic Strictures Following Resection of Esophageal Carcinoma

Esophageal carcinoma is the 3rd leading digestive malignancy in the U.S. Most pts are found to have advanced disease at the time of diagnosis. Surgical resection remains the only effective curative option. Complications include anastomotic strictures which approaches 10% in reported series. Few endoscopic treatment options have been previously reported. Aim: To determine the safety and effectiveness of endoscopic balloon dilatation of anastomotic strictures following esophagectomy. Method: 13 patients (11 M, 2 W, age 49-70, mean 67) presented with symptoms of dysphagia with or without odynophagia, 6 wks-13 mo following esophagectomy.

Fluoroscopically Guided Balloon Dilation of Anastomotic Strictures After Total Gastrectomy: Long-Term Results

The purpose of this study was to evaluate the radiologic and clinical effectiveness and long-term results of fluoroscopically guided balloon dilation of anastomotic strictures after total gastrectomy. Fluoroscopically guided balloon dilation is effective and safe and has encouraging long-term results in the management of benign anastomotic strictures after total gastrectomy.