Balloon Dilation In Patients Research Articles

GW24-e1208 Anterograde catheter interventional therapy for critical neonatal aortic stenosis

ObjectivesTo evaluate our experience with anterograde balloon dilation in patients with critical aortic stenosis.MethodsRetrospective review of the angiograms, the hemodynamic measurements and echocardiolograms of 17 neonates patients with critical aortic...

Su1516 The Residual Fraction of Radionuclide Is a Significant Marker for Prediction After Balloon Dilatation in Patients With Primary Achalasia

included elderly patients ( 60 years) with achalasia. The diagnosis was made based on clinic, endoscopic, radiologic and manometric parameters. Characteristics of the patients before, during and after BS placement were documented. Mellow score was used to evaluate dysphagia (0 no dysphagia/1 normal solids/2 dysphagia to soft solids/3 to solids and liquids/4 inability to swallow saliva), we measure the LES pressure and the barium column height at 1 min after swallow. The patients were followed weekly during the first three months after placement then each 15 days until the sixth month and then monthly P 0.05 was considered statically significant. Results: 10 patients with achalasia were included (7men and 3 women). Mean age was 76 7.8 years. Main symptoms were dysphagia and weight loss. Endoprostheses were successfully placed in all cases without complications however all presented chest pain during the first 72hours that was controlled with oral medication. 6 months (3-10) was the mean following period none of the stent was removed. The mean placement time was 35 8.3min. Migration occurred in 2 patients after 7 and 15days but none presented intestinal obstruction or other complication and both then received BTI. The mean degradation time was 80 20 days. Dysphagia score improved in all patients and 2 were able to eat normal diet at the end of the treatment. The mean basal LES pressure decreased 11.7 2.1mmHg (p 0.01) after treatment. Barium column height decreased 4.2 2.5cms after treatment (p 0.022). Final mean weight gain after treatment was 25 8% (p 0.017). Table 1 Conclusion: BS represents a safe and effective treatment in elderly patients with achalasia

Papillary balloon dilation in patients with bile duct stones is not a cause of post-ERCP pancreatitis by itself; results of anterograde and retrograde papillary balloon dilation

s / Pancreatology 13 (2013) e1–e94 e20 metalloproteinases-1) genes. HPSC expressed all four EP (EP1-4) receptors. Only blocking the EP4 receptor resulted in abrogation of PGE2 mediated HPSC activation. Specificity of EP4 for the effects of PGE2 on stellate cells was confirmed using specific antagonists. Conclusion: Our data indicate that PGE2 regulates PSC profibrotic activities via EP4 receptor thus suggesting EP4 receptor as useful therapeutic target for pancreatic cancer to reduce desmoplasia.

Fluoroscopically Guided Balloon Dilation for Postintubation Tracheal Stenosis

Little was known about the safety and long-term efficacy of fluoroscopically guided balloon dilation for postintubation tracheal stenosis. The purpose of this study was to evaluate the safety and long-term efficacy of fluoroscopically guided balloon dilation in patients with postintubation tracheal stenosis. From February 2000 to November 2010, 14 patients underwent fluoroscopically guided balloon dilation for postintubation tracheal stenosis. Technical success, clinical success, and complications were evaluated. Patients were followed up for recurrent symptoms. In all patients, fluoroscopically guided balloon dilation was technically and clinically successful with no major complications. Following the initial procedure, six patients (43 %) remained asymptomatic during a follow-up period. Obstructive symptoms recurred in eight patients (57 %) within 6 months (mean, 1.7 months), who were treated with repeat balloon dilation (n = 4) and other therapies. Of the four patients who underwent repeat balloon dilation, three became asymptomatic. One patient became asymptomatic after a third balloon dilation. On long-term (mean, 74 months) follow-up, 71 % of patients experienced relief of symptoms following fluoroscopically guided balloon dilation. Fluoroscopically guided balloon dilation may be safe, is easy to perform, and resulted in effective treatment in patients with postintubation tracheal stenosis.

Endoscopic papillary large balloon dilation in patients with periampullary diverticula

To evaluate the safety and effectiveness of endoscopic papillary large balloon dilation (EPLBD) for bile duct stone extraction in patients with periampullary diverticula. The records of 223 patients with large common bile duct stones (≥ 10 mm) who underwent EPLBD (12-20 mm balloon diameter) with or without limited endoscopic sphincterotomy (ES) from July 2006 to April 2011 were retrospectively reviewed. Of these patients, 93 (41.7%) had periampullary diverticula (PAD), which was categorized into three types. The clinical variables of EPLBD with limited ES (EPLBD + ES) and EPLBD alone were analyzed according to the presence of PAD. Patients with PAD were significantly older than those without (75.2 ± 8.8 years vs 69.7 ± 10.9 years, P = 0.000). The rates of overall stone removal and complete stone removal in the first session were not significantly different between the PAD and non-PAD groups, however, there was significantly less need for mechanical lithotripsy in the PAD group (3.2% vs 11.5%, P = 0.026). Overall stone removal rates, complete stone removal rates in the first session and the use of mechanical lithotripsy were not significantly different between EPLBD + ES and EPLBD alone in patients with PAD (96.6% vs 97.1%; 72.9% vs 88.2%; and 5.1% vs 0%, respectively). No significant differences with respect to the rates of pancreatitis, perforation, and bleeding were observed between EPLBD + ES and EPLBD alone in the PAD group (3.4% vs 14.7%, P = 0.095; 0% vs 0%; and 3.4% vs 8.8%, P = 0.351, respectively). EPLBD with limited ES and EPLBD alone are safe and effective modalities for common bile duct stone removal in patients with PAD, regardless of PAD subtypes.

Two‐year results: transantral balloon dilation of the ethmoid infundibulum

Multiple prospective and retrospective studies have reported results from balloon-only procedures and hybrid balloon sinus surgeries through intermediate follow-up periods of up to 1 year. Long-term durability results beyond 2 years are limited. One-year results from the original study of standalone transantral balloon dilation in patients with computed tomography (CT) evidence of chronic inflammation in the maxillary sinuses alone or maxillary and anterior ethmoid sinuses combined were previously reported. Revision rate, symptom improvement, and productivity improvement were prospectively evaluated after a minimum follow-up of 2 years. Fifty-nine patients (107 maxillary ostia) underwent balloon dilation of the maxillary sinus outflow tract and completed postprocedure follow-up assessment at 27.0 ± 3.6 months. Patient 20-item Sino-Nasal Outcome Test (SNOT-20) score improved from 2.65 ± 0.97 at baseline to 0.79 ± 0.71 at long-term follow-up (p < 0.0001). Improvement in work productivity and activity due to sinus-related health issues for all patients was statistically significant across all survey instrument characteristics (p range, <0.0001 to 0.02). An analysis of the outcomes in a subgroup of patients with maxillary and anterior ethmoid disease (20; 34%) showed similar significant improvement in symptoms (SNOT-20 decrease = -2.1; p < 0.0001). Approximately 92% of all patients reported satisfaction with the balloon procedure. Four (6.8%) patients underwent revision sinus surgery at 11.1 ± 7.3 months after treatment. Patients with chronic rhinosinusitis and radiographic evidence of isolated maxillary disease with or without anterior ethmoid disease have reported clinically meaningful and statistically significant improvement in symptoms, productivity, and activity through a minimum of 2 years following standalone balloon dilation.

Mo1478 Effects of Somatostatin and Gabexate Mesylate on the Prophylaxis of Pancreatitis and Hyperamylasemia Occurred After Endoscopic Papillary Balloon Dilation in Patients With Choledocholithiasis: A Prospective, Randomized, Placebo-Controlled Trial: Interim Analysis

Endoscopic papillary balloon dilation (EPBD) has been regarded as a less traumatic approach than endoscopic sphincterotomy (EST) for the treatment of bile duct stones. But, the incidence of pancreatitis in larger studies of EPBD ranges from 5% to 6.9%, higher than the EST. We evaluated the prophylactic effects of either Somatostatin or Gabexate mesylate on post-EPBD pancreatitis and hyperamylasemia.

Randomized Comparison of Final Kissing Balloon Dilatation Versus No Final Kissing Balloon Dilatation in Patients With Coronary Bifurcation Lesions Treated With Main Vessel Stenting

It is unknown whether the preferred 1-stent bifurcation stenting approach with stenting of the main vessel (MV) and optional side branch stenting using drug-eluting stents should be finalized by a kissing balloon dilatation (FKBD). Therefore, we compared strategies of MV stenting with and without FKBD. We randomized 477 patients with a bifurcation lesion to FKBD (n=238) or no FKBD (n=239) after MV stenting. The primary end point was major adverse cardiac events: cardiac death, non-procedure-related index lesion myocardial infarction, target lesion revascularization, or stent thrombosis within 6 months. The 6-month major adverse cardiac event rates were 2.1% and 2.5% (P=1.00) in the FKBD and no-FKBD groups, respectively. Procedure and fluoroscopy times were longer and more contrast media was needed in the FKBD group than in the no-FKBD group. Three hundred twenty-six patients had a quantitative coronary assessment. At 8 months, the rate of binary (re)stenosis in the entire bifurcation lesion (MV and side branch) was 11.0% versus 17.3% (P=0.11), in the MV was 3.1% versus 2.5% (P=0.68), and in the side branch was 7.9% versus 15.4% (P=0.039) in the FKBD versus no-FKBD groups, respectively. In patients with true bifurcation lesions, the side branch restenosis rate was 7.6% versus 20.0% (P=0.024) in the FKBD and no-FKBD groups, respectively. MV stenting strategies with and without FKBD were associated with similar clinical outcomes. FKBD reduced angiographic side branch (re)stenosis, especially in patients with true bifurcation lesions. The simple no-FKBD procedures resulted in reduced use of contrast media and shorter procedure and fluoroscopy times. Long-term data on stent thrombosis are needed. Clinical Trial Registration- URL: http://clinicaltrials.gov. Unique identifier: NCT00914199.

Predictors for outcome of failure of balloon dilatation in patients with achalasia

BackgroundPneumatic balloon dilatation (PD) is a regular treatment modality for achalasia. The reported success rates of PD vary. Recurrent symptoms often require repeated PD or surgery.ObjectiveTo identify predicting factors for...

Clinical Study on Combined Therapy of Botulinum Toxin Injection and Small Balloon Dilation in Patients with Esophageal Achalasia

Background and Study Aims: To compare the efficiency of pneumatic balloon dilation, botulinum toxin (BT) injection, and the combination of the two modalities in the management of esophageal achalasia. Patients and Methods: Ninety patients with esophageal achalasia were randomly divided into three groups according to different interventions, i.e. patients in group A received 100 U BT injection; patients in group B were given balloon dilation, and patients in group C were subjected to balloon dilation plus 100 U BT injection 15 days after the dilation. Clinical assessment and esophageal manometry were performed by experienced gastroenterologists. All patients were followed-up for more than 2 years. Results: At any time after the treatment, the lower esophageal sphincter pressure and symptom score in group C were lower compared with those in group A or group B (p < 0.05). At 2 years after treatment, the response rate in group C remained 56.67%, still higher than those in the other groups (p < 0.05); the response rate in group B was only 35.71% (10/28); the response rate in group A was 13.79%, the lowest among the three groups. Conclusions: The efficiency of the combination of 100 U BT administration and small balloon dilation is superior to the single modality approach.

Endoscopic stone removal using a scissors papillotome followed by papillary balloon dilation in patients with Billroth II gastrectomy – a case series

Endoscopic sphincterotomy (EST) for endoscopic removal of bile duct stones is difficult in patients with a Billroth II gastrectomy. We retrospectively evaluated the usefulness of an endoscopic scissors papillotome by performing EST with subsequent endoscopic papillary balloon dilation (EPBD) for the removal of bile duct stones in 12 patients with a previous Billroth II gastrectomy. EST using the scissors papillotome was performed successfully in all patients. Endoscopic stone removal was successful in 11 patients, and lithotripsy was required in three patients. No significant procedure-related complications occurred. Preceding sphincterotomy using a scissors papillotome followed by papillary balloon dilation seems to be feasible and effective for the endoscopic removal of bile duct stones in patients with a Billroth II gastrectomy.

T1407 Efficacy of Pyloric Botulinum Toxin Injection and Pneumatic Balloon Dilation in Patients with Gastroparesis Refractory to Medical Treatment. a Retrospective Cohort Study

T1407 Efficacy of Pyloric Botulinum Toxin Injection and Pneumatic Balloon Dilation in Patients with Gastroparesis Refractory to Medical Treatment. a Retrospective Cohort Study

Late Complications of Endoscopic Sphincterotomy in Comparison to Endoscopic Papillary Balloon Dilation in Patients with Bile Duct Stones: A Randomized Controlled Multicenter Trial

Although endoscopic sphincterotomy (EST) is a well-established standard treatment for common bile duct stones, the papillary function is damaged after this treatment. However, it remains unclear whether or not the reduced papillary function causes any late clinical complications. On the other hand, endoscopic papillary balloon dilation (EPBD) is another option for the extraction of bile duct stones, and the papillary function is preserved better than after EST. Aim: To compare the long-term complications between EST and EPBD for stone removal. Methods: From March 2000 to March 2001, a randomized, controlled multicenter trial was carried out at 11 institutions in Japan. Two hundred eighty-two patients with bile duct stones smaller than 14 mm in size were randomly assigned to EST and EPBD groups. The follow-up data of them, 144 patients after EST and 138 patients after EPBD, were collected. Results: The baseline characteristics of the patients were similar between the two groups. The gall bladder was left in situ after the treatment in 72 patients (50%) from the EST group and in 55 patients (40%) from the EPBD group, and gall bladder stones remained in 38 patients (26%) from the EST group and in 31 patients (22%) from the EPBD group. The median duration of the follow-up was 2,451 days and 2,409 days, for the EST group and the EPBD group, respectively. Morbidity was observed in 40 patients (28%) and 18 patients (13%), from the EST group and the EPBD group, respectively. Such morbidity included: recurrent bile duct stones in 25 and 12; cholangitis without stone recurrence in 3 and none; liver abscess in 2 and none; cholecystitis in 6 and 3; and new appearance of gall bladder stones in 5 and 4, respectively. One patient of the EST group died due to sepsis from liver abscess. Gall bladder cancer was found in one patient 561 days after undergoing EST. A Kaplan-Meier analysis revealed a significantly lower incidence of biliary complications such as recurrent bile duct stones and cholangitis in the EPBD group than in the EST group. Conclusions: The occurrence of papillary dysfunction after EST may therefore result in additional late complications during the long-term follow-up.

Pressure Wave Reflection After Successful Balloon Dilatation of Aortic Coarctation

After successful surgical repair in patients with aortic coarctation, the early onset of cardiovascular diseases is an important subsequent complication and one of the causes is the enhanced aortic pressure wave reflection. Balloon angioplasty has become established as an effective alternative to surgery, but there have been no reports regarding pressure wave reflection after balloon dilatation in patients with aortic coarctation. A 29-year-old patient with aortic coarctation was admitted for angioplasty, which was performed successfully. Six months later, catheter examination demonstrated enhanced aortic pressure wave reflection, although there was no pressure difference. After balloon dilatation patients with aortic coarctation may be also at high risk for future cardiovascular diseases.

Fluoroscopically Guided Balloon Dilation for Patients with Esophageal Stricture after Radiation Treatment

To evaluate the safety and clinical effectiveness of fluoroscopically guided balloon dilation in patients with esophageal stricture after radiation therapy (RT). 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. 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. Fluoroscopically guided balloon dilation for esophageal stricture after RT can be safe and effective. However, the high rate of recurrent dysphagia requires repeated dilations.

Endoscopic Papillary Balloon Dilation in Patients Undergoing Hemodialysis

Endoscopic Papillary Balloon Dilation in Patients Undergoing Hemodialysis

Endoscopic balloon dilation for benign gastric outlet obstruction with or without Helicobacter pylori infection

Background Endoscopic balloon dilation has been used to treat patients with gastric outlet obstruction caused by peptic stricture. This study assessed the role of endoscopic balloon dilation in patients with gastric outlet obstruction with or without Helicobacter pylori infection. Methods Consecutive patients seen between January 1996 and September 2001 with benign gastric outlet obstruction (defined as stenosis preventing the passage of a 9 mm diameter endoscope, vomiting, succussion splash, and recent weight loss) were prospectively studied. Exclusion criteria were the following: refusal to undergo dilation, and gastric outlet obstruction because of malignancy. At endoscopy, antral biopsy specimens were obtained for histopathologic evaluation and for a rapid urease test for Helicobacter pylori infection. Patients then underwent dilation with through-the-scope balloons. After balloon dilation, patients with Helicobacter pylori infection were treated to eradicate the infection. Results Fifty-one patients (33 men, 18 women; median age 65 years; IQR 44–79 years) were studied; 33 consented to endoscopic balloon dilation. Symptom resolution occurred in 25 patients (14 Helicobacter pylori positive, 11 Helicobacter pylori negative). During a median follow-up of 24 months (IQR 16–40 months), 3 of 14 patients in the Helicobacter pylori positive group and 6 of 11 in the Helicobacter pylori negative group developed further ulcer complications (p = 0.039). Conclusions: After endoscopic dilation for gastric outlet obstruction, eradication of Helicobacter pylori infection is associated with fewer ulcer complications.

The usefulness of the endoscopic papillary balloon dilation in patients with Billroth II gastrectomy for management of bile duct stones

The usefulness of the endoscopic papillary balloon dilation in patients with Billroth II gastrectomy for management of bile duct stones

Percutaneous balloon dilatation for benign hepaticojejunostomy strictures.

Percutaneous balloon dilatation of biliary tract strictures is generally accepted as a safe and inexpensive procedure. The effectiveness in selected groups of patients remains under discussion. The purpose of this study was to evaluate the results of percutaneous balloon dilatation in patients with a benign stricture of a hepaticojejunostomy. Fifteen patients with a benign stricture of a hepaticojejunostomy were examined between 1993 and July 1997. An ultrasound-guided percutaneous transhepatic cholangiography (PTC) procedure was performed, followed by a balloon dilatation. Follow-up was performed prospectively by outpatient visits and laboratory testing. Percutaneous dilatation was successful in 14 patients. Three patients developed a recurrence. In one of these patients, the procedure was repeated successfully. Gastrointestinal bleeding occurred in one patient. The success rate for balloon dilatation in this group of patients was 73% after a mean follow-up of 30 months. When the procedure was repeated, the success rate was 80% after a mean follow-up of 33 months. Percutaneous balloon dilatation for benign hepaticojejunostomy strictures is feasible in the majority of patients and produces acceptable medium-term to long-term results. Advantages are its minimal invasive character and the fact that all options remain open in case of failure.

Balloon Pulmonary Valvuloplasty

Since the initial description of balloon pulmonary valvuloplasty in 1982 by Kan and her associates, the procedure has been extensively used by several groups of workers for relief of pulmonary valve stenosis. It is generally recommended that the procedure be performed for peak‐to‐peak gradients in excess of 50 mmHg. Severe and critical obstructions, irrespective of age and pulmonary valve dysplasia, are amenable to balloon dilatation. The technique involves positioning one or more balloon catheters across the stenotic valve, usually over an extra‐stiff guidewire and inflating the balloons, thus producing valvotomy. The recommended balloon:annulus ratio is 1.2 to 1.4. Immediate reduction of gradient, increase in jet width, and free motion of the pulmonary valve leaflets with less doming have been observed following balloon dilatation. Improvement of right ventricular function, tricuspid insufficiency, and right‐to‐left shunt has also occurred. At intermediate‐term follow‐up, both catheterization measured peak‐to‐peak gradients and Doppler‐measured peak instantaneous gradients remain improved for the group as a whole. However, restenosis, defined as gradient ≥ 50 mmHg, has been observed in nearly 10% of children. Predictors of restenosis include balloon:annulus ratio ≥ 1.2 and immediate postvalvuloplasty gradient ≥ 30 mmHg. Small pulmonary valve annulus, earlier study year, and postsurgical complex pulmonary stenosis have also been identified as factors predictive of restenosis. Redilatation with balloons that are larger than those used at the time of initial balloon valvuloplasty produces excellent results, and redilatation is the procedure of choice in the management of restenosis after previous balloon pulmonary valvuloplasty. Regression of right ventricular hypertrophy on ECG following balloon dilatation has been well documented; ECG is a useful adjunct in the evaluation of results of balloon dilatation. However, ECG evidence for hemodynamic improvement does not become apparent until 6 months after balloon dilatation. Doppler gradient is generally reflective of residual obstruction and is a useful and reliable noninvasive monitoring tool. Infundibular gradients occur in nearly 30% of patients: the older the age and higher the severity of obstruction, the higher the prevalence of infundibular reaction. When residual infundibular gradient is ≥ 50 mmHg, beta blockade therapy is generally recommended. The infundibular obstruction regresses to a great degree at follow‐up with the rare patient requiring surgical intervention. While there is some controversy with regard to use of balloon dilatation in patients with dysplastic pulmonary valves, based on our own observations and those of others, the results of balloon valvuloplasty with dysplastic pulmonary valves are comparable to those without. Dysplastic valves did not seem to be responsible for recurrence, and balloons large enough to produce balloon:annulus ratio of 1.4:1.5 may be needed to produce a satisfactory result. Comparison with surgical valvotomy has limitations, but generally there is greater reduction of gradient following surgery, but the degree and frequency of pulmonary insufficiency may be higher following surgery than after balloon therapy. Long‐term follow‐up results are scanty, but the data from our cohort reveal minimal additional restenosis, event‐free rates of 88% and 84% at 5 and 10 years, respectively, and significant increase in the prevalence of pulmonary insufficiency. But, no surgical intervention was warranted for pulmonary insufficiency in any patient following balloon dilatation. In conclusion, balloon pulmonary valvuloplasty is the treatment of choice for relief of pulmonary valve stenosis. Use of balloons 1.2‐1.4 times larger than pulmonary valve annulus may produce optimal results. Ten‐ to 20‐year follow‐up to identify the significance of residual pulmonary insufficiency is indicated.