Balloon Tuboplasty Research Articles

Low-temperature plasma radiofrequency ablation tuboplasty and myringotomy: A preliminary report

ObjectiveTo evaluate the efficacy of Low-temperature plasma radiofrequency ablation (RF) tuboplasty and myringotomy for treating chronic otitis media with effusion (COME) with chronic obstructive eustachian tube dysfunction (COETD) involving hypertrophic tissue of the ET orifice. Methods and materialsThis was a prospective study of 43 ears with COME and COETD who underwent RF tuboplasty. Outcomes included the ability to perform a Valsalva maneuver, tympanometry results, and TM status. Success was defined by an improvement in tympanogram type and Valsalva maneuver. Follow-up ranged from 4 weeks to 12 months. ResultsA total of 43 ears (43 patients) were included in the study. Mucosal hypertrophy of the ET orifice was seen in 35 (81.4 %) patients, while polypoid tissue was observed in 8 (18.6 %) patients. All patients completed the 12-month follow-up, the success rate was 95.3 % (41/43) at postoperative 3 months, 39/43 (90.4 %) at postoperative 6 months, and 37/43 (86.0 %) at postoperative 12 months. No procedure-related serious adverse events were reported for any patient, and there were no cases of patulous ET. Stenosis/scar of anterior-post wall in the ET orifice occurred in two patients at 6 months postoperatively and in one patient at 12 months postoperatively, which the Valsalva maneuver was positive. Thus, no further treatment was applied for the ET orifice in 3 patients. The risk of stenosis of the ET orifice was 3/47 (6.4 %). ConclusionsRF eustachian tuboplasty may be an effective treatment for patients with COME, COETD and hypertrophic mucosa in the ET orifice, particularly as an adjunct to balloon tuboplasty.

A Novel Method to Treat Obstructive Eustachian Tube Dysfunction in the Mucosal Type of Chronic Otitis Media

Abstract Introduction Treatment of Eustachian tube dysfunction has remained an enigma for a long time. Balloon tuboplasty, even though effective, is not considered by many, as it is invasive, expensive, and cumbersome. Hence, we tried to find some simple and inexpensive solution for the same in chronic otitis media. In this background, we evaluated the use of the Eustachian barotubometer to treat obstructive Eustachian tube dysfunction in mucosal chronic otitis media. Materials and Methods The pilot study was undertaken in a tertiary referral hospital with 25 cases and 30 controls. Case group patients were administered Eustachian barotubometer therapy along with ciprofloxacin-dexamethasone ear drops and xylometazoline nasal drops until the recovery or up to 10 days. Control group patients received the same ear and nasal drops along with Valsalva maneuver for the same duration. Results The recovery of the Eustachian tube was categorized as complete, partial, or nil. It was found that the case group had 60 and 32% complete and partial recovery, respectively, while it was 33.33 and 13.33% in the control group. The recovery was faster with Eustachian barotubometer therapy than with the Valsalva maneuver. No complications were observed with the new procedure. Conclusion The Eustachian barotubometer is a simple, inexpensive device that can be used to treat Eustachian tube dysfunction in chronic otitis media. This device is particularly suitable for the peripheral health care centers of developing countries.

Extensive Cervicofacial Emphysema After Eustachian Tube Balloon Tuboplasty.

Department of Otolaryngology—Head and Neck Surgery, Changi General Hospital, Singapore Address correspondence and reprint requests to Heng Wai Yuen, M.Med. (O.R.L.), F.A.M.S. (O.R.L.), M.H.P.E. (Maastricht), Department of Otolaryngology–Head and Neck Surgery, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore; E-mail: [email protected] The authors have no financial disclosures or conflict of interest. Supplemental digital content is available in the text.

Efficacy of Balloon Tuboplasty for Baro-Challenge-Induced Eustachian Tube Dysfunction: A Systematic Review and a Retrospective Cohort Study of 39 Patients.

Baro-challenge-induced Eustachian tube dysfunction (ETD) manifests due to inadequate Eustachian tube (ET) function during rapid ambient pressure changes, although ET function may be normal in normobaric situations. This systematic review and retrospective cohort study aimed to evaluate the effectiveness of balloon Eustachian tuboplasty (BET) for the treatment of baro-challenge-induced ETD. PubMed, the Cochrane Library, Scopus, and Helsinki University Hospital cohort. A systematic literature search was conducted in November 2020 and resulted in 174 articles. Eight articles fulfilled the inclusion criteria. Data was available altogether from 74 adult baro-challenge-induced ETD patients. In addition, we retrospectively evaluated 39 BET operations at Helsinki University Hospital from 2011 to 2020. Data from these 39 patients were collected from medical charts, and a questionnaire was sent to the patients. Meta-analysis was used to evaluate subjective symptom improvement, changes in ETD Questionnaire-7 (ETDQ-7) scores, and Valsalva maneuver performance. In the systematic review, the outcome parameters varied between studies. Improvement was reported in subjective symptoms, Valsalva maneuver, ETDQ-7, tubomanometry, and pressure chamber test. Response rate for the Helsinki University Hospital cohort study was 72% (28/39). Mean follow-up time from the BET to the questionnaire was 4 years 8 months (SD 26months). Of those patients 93% (26/28) found the operation beneficial. Meta-analysis including up to 113 patients showed improvement in Valsalva maneuver, ETDQ-7, and improvement in subjective symptoms. Overall improvement in symptoms was noted in 81% of the patients. BET seems to be effective in the majority of patients with baro-challenge-induced ETD.

Outcome of Balloon Eustachian Tuboplasty in SCUBA Divers.

Good Eustachian tube (ET) function is necessary in order to equalize middle ear (ME) pressure with ambient pressures and avoid barotrauma among divers. Since placement of ventilation tubes is not compatible with diving, balloon eustachian tuboplasty is a potential surgical solution for divers with ET dysfunction (ETD). This is the first report of the outcome of balloon tuboplasty for ETD among divers. A retrospective analysis of medical records and clinical examinations of adult divers treated in a single tertiary medical center. Four male divers (age range 21-71 years, 5 ETs) underwent balloon tuboplasty for ETD. None had identifiable risk factors for ETD. Symptom duration ranged from 2 to 5 years and was restricted to diving in 3 patients. The most common symptom was difficulties in equalizing air pressure during descent and ascent, followed by aural fullness and hearing loss. The validated Hebrew version of ETD-7 questionnaire (ETDQ-7H) results were normal in 3 ears and pathological (2.9 and 3.3) in 2 ears. The averaged postoperative ETDQ-7H score was 1.2 points, significantly better than the preoperative score (P < .05). While diving, pressure-equalizing sensation improved in all ears. Balloon eustachian tuboplasty is a safe method for treating diving-induced baro-challenge ETD. This procedure can improve symptoms and enable the patient to resume diving.

A Systematic Literature Review of the Safety and Efficacy of Eustachian Balloon Tuboplasty in Patients with Chronic Eustachian Tube Dysfunction

Eustachian tube dysfunction (ETD) is a common condition afflicting 1% of the adult population and is said to be higher in the pediatric population. Currently, it is primarily managed with medical therapy. However, newer management techniques like balloon tuboplasty have been introduced. To systematically review the available evidence on eustachian tube balloon dilation for treating chronic ETD covering indications, efficacy, safety, short term, and long term outcomes, a literature search was conducted on Google Scholar and Pubmed. 21 publications met the inclusion criteria. Based on the literature review the procedure was found to be effective in alleviating symptoms in adult and pediatric patients immediately postoperatively and long term, up to 5years. The adverse event rate was 3% and these were mostly minor self-resolving complications. The perioperative protocol varies from center to center. Balloon tuboplasty was found to be safe and efficacious in the short and long term post operatively in select patients with chronic ETD.

Comparison of Balloon Dilation and Laser Eustachian Tuboplasty in Patients with Eustachian Tube Dysfunction: A Meta-analysis.

Objective We aimed to perform a meta-analysis examining balloon dilatation and laser tuboplasty for the treatment of eustachian tube dysfunction (ETD). Data Sources PubMed, Cochrane, and Embase search up to April 18, 2016, with the following keywords: eustachian, middle-ear, eustachian tuboplasty, balloon tuboplasty, laser tuboplasty, laser dilatation, and balloon dilatation. Review Methods Randomized controlled trials and prospective, retrospective, and 1-arm studies of patients with ETD treated with balloon dilatation or laser tuboplasty were included. Outcome measures were improvement of eustachian tube score (ETS) and tympanometry and Valsalva maneuver results. Results Two retrospective and 11 prospective studies were included (1063 patients; 942 treated with balloon and 121 with laser tuboplasty). Balloon tuboplasty resulted in a significant improvement of ETS (pooled standardized mean difference [SMD], 0.94; 95% confidence interval [CI], 0.23-1.66; P = .009) and, compared with laser tuboplasty, a greater tympanometry improvement rate (pooled event rate = 73% vs 13%; P = .001). Valsalva maneuver improvement rate was not different between the group results (pooled event rate = 67% vs 50%; P = .472). The maximum number of studies that provided outcome data for any one measure was only 4, and sensitivity analysis indicated ETS results may have been overly influenced by 2 studies. No balloon tuboplasty studies reported ETS data, preventing comparison between the 2 procedures. Conclusion Both procedures can improve symptoms of ETD; however, because of the limited numbers of studies reporting data of the outcomes of interest, it remains unclear if one procedure provides greater benefits.

The efficacy of surgical treatment of Eustachian tube dysfunction in children with exudative otitis media

In this study the authors evaluated the possibilities of the advanced surgical correction of Eustachian tube dysfunction in children with exudative otitis media, including the new method of treatment of persistent tube dysfunction – the balloon tuboplasty. The study is based on the data obtained in the process of examination and treatment of 190 patients with exudative otitis media aged from 3 to 13 years. It has been found that the main cause of chronic exudative otitis media was the obsturative dysfunction of Eustachian tube, related to the presence of degree 3–4 adenoid vegetations, degree 2 adenoid vegetations combined with the hypertrophy of Eustachian cushion cartilage tissue, degree 2 adenoid vegetations combined with the Eustachian tonsil hypertrophy, stenosis of Eustachian tube cartilage area in children. Based on the data obtained during the treatment session including the endoscopically controlled isolated adenotomy or isolated adenotomy in combination with myringotomy, tympanic cavity shunting, instrumental correction of Eustachian cushion, Eustachian tonsil destruction, the authors have drawn a concussion about efficacy of the treatment applied (84.7%), however, they have singled out a group of children with persistent Eustachian tube dysfunction who need the application of balloon tuboplasty method, which has proven a high efficacy in most patients (76%) of this study.

Balloon tuboplasty in patients with Eustachian tube dysfunction: a prospective study in 39 patients (55 ears).

Eustachian tube dysfunction (ETD) is estimated to affect approximately 1% of the UK population.1 ETD and subsequent inadequate middle ear ventilation has been implicated in the pathogenesis of otological diseases including otitis media with effusion (OME), retraction pockets, tympanic membrane (TM) perforation and cholesteatoma.2 This article is protected by copyright. All rights reserved.

Does balloon dilatation represent a breakthrough for Eustachian tube disorders – even in children?

Balloon dilatation is a promising new treatment for Eustachian tube dysfunction which is becoming more and more popular in Germany. There are a number of single publications and even meta-analyses on this topic, which demonstrate good results but also reveal the need for better studies. Initially tube dilatation was applied only in adults with tube dysfunctions but recently some centers even recommend it for children with long-lasting or frequently recurring middle ear effusion, which is resistant to conventional therapy. This article provides a critical appraisal based on the current literature and emphasizes the need for controlled studies. Due to the poor definition of tube dysfunctions it may be difficult to establish informative studies but in terms of evidence-based medicine there is need for a precise definition of indications and inclusion criteria. Most important is that such studies must include control groups, which has so far not been the case. Moreover, there should be a consensus about the criteria for defining success. Although all publications claim that balloon tuboplasty is a safe method, the question whether or not preoperative computed tomography (CT) scans are needed should be considered in each individual case. Nevertheless, balloon dilatation is a very promising method offering a new approach to the problem of Eustachian tube dysfunction.

Eustachian tube and middle ear mechanics

Even the most sophisticated prostheses for reconstruction of the ossicular chain do not work in the presence of Eustachian tube dysfunction. This review gives an update on the mechanisms of middle ear pressure regulation and middle ear ventilation, as well as methods for measuring the opening and closing function of the Eustachian tube. So far, in most tube function tests pressures are applied far beyond the physiological range in order to open the tube or force it to open. New methods like sonotubometry with perfect sequences (PSEQ) or the application of pressure in the nasopharynx with the Estève technique seem very promising. However, these measurements only provide snapshots of tube function. Presently, new tests are being developed for long-term measurements even in cases with perforated tympanic membranes. Attempts to improve impaired tube function have recently included laser surgery and balloon tuboplasty, yielding positive long-term results requiring verification in larger controlled studies. Eustachian tube dysfunction does not only mean blockage but can also include abnormal patencies of the Eustachian tube, for which new approaches are discussed here. In the case of suspected tube dysfunction, cartilage should be used to avoid early tympanic retraction or recurrent perforation; external ventilation using ventilation tubes should be considered.

Falloposcopic tuboplasty (FT) Is a novel, patient friendly and effective treatment for tubal factor infertility

OBJECTIVE: Tubal factor is a major cause of female infertility. The narrowest portion of the human fallopian tube, extending from the uterotubal ostium to the ampullary-isthmic junction is vulnerable to pathogenic organisms and often causes infertility by occlusion (Oc) or stenosis (St). FT is the procedure of transcervical balloon tuboplasty and can be performed outpatient bases. Although ART has been used for tubal factor as standard treatment, we apply FT as an initial treatment. The present study was conducted to evaluate whether outpatient FT is effective to recover tubal patency and achieve pregnancy from our experience of 1500 cases.

Experience of 1000 falloposcopic tuboplasty (FT) cases: FT is a novel, patient friendly and effective regimen for tubal factor infertility before ART

OBJECTIVE: Tubal factor is a major cause of female infertility. The narrowest portion of the fallopian tube, extending from uterotubal ostium to ampullary-isthmic junction, is vulnerable and often causes infertility by occlusion (Oc) or stenosis (St). FT is the procedure of transcervical balloon tuboplasty combined with retrograde imaging of endotubal lining and can be performed outpatient bases. Although ART has been used for tubal factor as standard treatment, we apply FT as an initial treatment. The present study was conducted to evaluate whether outpatient FT is effective to recover tubal patency and achieve pregnancy from our experience of 1000 cases. DESIGN: Retrospective study at private setting infertility clinic. MATERIALS AND METHODS: One thousand patients with tubal Oc and/or St either unilaterally or bilaterally diagnosed by hysterosalpingography were treated by FT from January, 2002 through June, 2007. Indications for FT were tubal lesions without hydrosalpinges. Severe male factor patients were excluded. FT were performed under uterine cervical block. Eversion balloon catheter of 6 cm was used to recanalize affected oviducts. It was considered successful when more than 5 cm of the balloon advanced from tubal ostium. Patients were followed by conventional infertility treatments such as timed intercourse or IUI for at least 6 months. Success of FT procedures and subsequent pregnancy were analyzed. RESULTS: Nine hundred eighty eight out of 1000 patients (98.8%) were treated successfully with FT. Overall pregnancy rate after FT was 27.1% (268/988). Twenty four point seven percent of patients (170/688) with bilateral tubal lesions (Oc&Oc;169pt., Oc&St; 217pt and St&St; 302pt.) and 34.8% of patients with unilateral tubal lesion (Oc;141pt. and St;140pt.) achieved pregnancy. Pregnancy and condition of tubal linings were as follows; post inflammation image: 25.3% (57/225pt.), adhesions: 31.6% (113/357pt.) and other abnormalities: 19.0% (111/583pt.). Six ectopic pregnancies (2.2%) took place. The pregnancy took place in 4 months and 23 days on average after FT. The average duration of infertility of pregnant patients was 3 years and 9 months. CONCLUSIONS: FT could be performed out patient bases and achieved acceptable pregnancy rate (27.1%) with reasonable ectopic rate for tubal factor infertility. Moreover, FT is not only bringing natural pregnancies, but also patient friendly procedure. The present study has proven that outpatient FT could be the first option for tubal factor infertility patients before IVF.

P-466: Falloposcopic tuboplasty (FT) is a novel, patient friendly and effective treatment for tubal factor infertility and should be used before In Vitro Fertilization (IVF) from the experience of 550 cases

Tubal factor is a major cause of female infertility. The narrowest portion of the human fallopian tube, extending from the uterotubal ostium to the ampullary-isthmic junction is vulnerable to pathogenic organisms and often causes infertility by occlusion or stenosis. Recently IVF has been the standard treatment for tubal factor infertility. Falloposcopic tuboplasty (FT) is the procedure of transcervical balloon tuboplasty combined with retrograde observation of endotubal lining and can be performed outpatient with local anesthesia.

Conservative surgical management of placenta percreta: two cases with an emphasis on tubal patency

A 32-year-old woman, gravida 2 para 1, was hospitalized in the 31st week of gestation with a diagnosis of preterm labor. Ritodrine tocolysis failed to control uterine contractions, and an emergency cesarean section was performed for a decelerative fetal heart rate tracing. After the infant was delivered, ligation of the bilateral uterine arteries and their anastomoses with the ovarian arteries was performed. A 4×6-cm ellipsoid area of the anterior uterine corpus with placenta percreta was excised. Unilateral tubal occlusion was noted on hysterosalpingography 3 months after surgery, but the patient refused further interventions. The second case we present is that of a 28-year-old woman, gravida 3 para 2, who had her third cesarean delivery at the 38th week of gestation because of bleeding from placenta previa. We performed a repeat laparotomy for decreasing hemoglobin levels and drained 1,600 ml of blood from the abdomen. The bilateral uterine arteries and their anastomoses with ovarian arteries were ligated. Retained placental fragments were removed, and the bleeding areas were sutured. Despite resuturing of the vertical incision, uterine bleeding and hypotonia were observed, and transuterine sutures were inserted. Unilateral left tubal occlusion was observed on hysterosalpingography 3 months after surgery, and hysteroscopic balloon tuboplasty and laparoscopic tubal adhesiolysis were performed.

Outpatient falloposcopic tuboplasty (FT) should be an initial regimen for tubal factor infertility due to tubal lumen lesions before in vitro fertilization (IVF)

Objective: Tubal factor is a major cause of female infertility. The narrowest portion of the human fallopian tube, extending from the uterotubal ostium to the ampullary-isthmic junction is vulnerable to pathogenic organisms and often become stenotic or occlusive. However, this portion is difficult to treat and recently IVF has been the standard treatment option for its lesion. Falloposcopic tuboplasty is the procedure of transcervical balloon tuboplasty combined with retrograde observation of endotubal lining. This is usually performed under concomitant laparoscopic observation. The present study was conducted to determine whether outpatient FT without laparoscopy is effective to re-establish tubal patency and lead to pregnancy. Design: Forty treatment cycles (39 patients) with unilateral or bilateral tubal stenosis and/or occlusion confirmed by hysterosalpingogram were studied. FT on outpatient basis was performed from April through December 2001. Re-canalization of the affected tubes and pregnancy outcomes were analyzed. Materials/Methods: Indications for FT are the patients with tubal lesions without hydrosalpinges. Severe male factor patients who need ICSI were excluded. Outpatient FT treatments were performed under light sedation between menstrual cycle day 5 and 14. It was considered successful when more than 10 cm of the balloon advanced into the tubes. More than 5 cm was considered fair. Those patients were followed prospectively after FT for at least 3 months to see if pregnancy occurred by timed intercourse or IUI. Results: A total of 62 tubes (38 occluded and 24 stenosis) were treated by FT. Fifty six tubes (90.3%) were re-canalized successfully. Three tubes (4.8%) were fairly re-canalized and 3 tubes (4.8%) were unsuccessful. Eleven clinical pregnancies (27.5%) were achieved 3 months in average after FT treatment and two of them were ectopic pregnancies (18.2%). Pregnancy rate of the patients with tubes bilaterally affected was significantly higher compared to the patients with tubes unilaterally affected (39.1% versus 11.8%, p <0.05). Their average infertile periods were 5 years and 3 months. Conclusions: IVF is a present first choice for tubal factor infertility, but IVF is still stressful economically and physically. On the other hand, pregnancies achieved by using fallopian tubes are not only inexpensive, but also easy for the patients from all aspects. Outpatient FT obtained acceptable pregnancy rate (27.5%) for tubal infertility especially for the patients with bilateral tubal lesions (39.1%). The present study suggests that outpatient FT could be a first option of treatments for tubal factor infertility. Outpatient FT has potential medical as well as economical advantages over surgical treatments and over IVF. Supported by: None.

Outpatient evaluation and treatment of tubal obstruction with selective salpingography and balloon tuboplasty

Objective: To compare selective salpingography and balloon tuboplasty for the treatment of tubal obstruction. Design: A retrospective evaluation of results of women treated for tubal obstruction by outpatient methods at a single center. Setting: Tertiary-care, university-affiliated hospital. Patient(s): A total of 3,424 infertile women, of whom 418 had bilateral tubal obstruction by hysterosalpingography, treated at Nihon Medical Center from 1982 to 1997. Intervention(s): Women with tubal obstructions who had visual evidence of an intact uterine tubal ostium at hysteroscopy were treated by selective salpingography. If selective salpingography could not establish patency, then transcervical balloon tuboplasty was performed with one of three catheter systems. Patients were followed expectantly for 1 year after treatment. Main Outcome Measure(s): Postoperative tubal patency and overall pregnancy rates (PRs) at 1-year of follow-up. Result(s): The overall patency rate was 67.5%, with 30% of these patients conceiving (20.2% of all subjects). Selective salpingography was associated with a 35.7% patency rate, and 27.3% of these patients conceived. Of the subjects who failed selective salpingography and underwent balloon tuboplasty, 66.2% achieved patency, of whom 33% spontaneously conceived. Balloon tuboplasty was effective in restoring patency in many cases after selective salpingography had failed. Statistically significant differences were found between selective salpingography and balloon tuboplasty and for the different balloon tuboplasty catheters in terms of patency rates, while a trend was seen for PRs. Conclusion(s): Many women diagnosed as having tubal obstruction can be treated by outpatient methods that do not require general anesthesia. Achieving patency by these methods is associated with high PRs and avoids the need for assisted reproductive technologies in some cases. Balloon tuboplasty is a more effective treatment than selective salpingography. The choice of balloon tuboplasty catheter system may affect success rates.

Sonographic transcervical balloon tuboplasty.

The purpose of this study was to evaluate sonographic guidance for transcervical tubal catheterization and transcervical balloon tuboplasty of patients with bilateral proximal tubal occlusion. Cornual catheterization and transcervical balloon tuboplasty were performed under sonographic guidance. Injection of micro-bubble emulsion confirmed tubal recanalization. Tubal patency demonstrated by sonography was confirmed by injection of contrast material under fluoroscopy. Four women with bilateral proximal tubal occlusion confirmed by previous hysterosalpingogram and laparoscopy underwent sonographically guided transcervical balloon tuboplasty. Patients with distal or peritubal damage were excluded from this study. Bilateral tubal patency confirmed by sonography and subsequent fluoroscopy was achieved in all four patients. One patient conceived spontaneously, a month following the procedure, and delivered at term. Sonographically guided transcervical balloon tuboplasty can be performed successfully on patients with proximal tubal occlusion. Identification of the catheter tip and successful cannulation of the internal tubal ostia were easier to perform under fluoroscopy. Further improvements in sonographic equipment and catheter technology will hopefully eliminate radiation and replace fluoroscopy during the performance of transcervical balloon tuboplasty. Sonographic transcervical tubal catheterization may, therefore, become a simple and cost-effective procedure for the diagnosis and treatment of patients with proximal tubal occlusion.

Falloposcopic classification and treatment of fallopian tube lumen disease

To devise a diagnostic classification and scoring system for tubal lumen disease based on falloposcopy and to evaluate it against tuboplasty procedures and pregnancy outcomes. Prospective study approved by the hospital Institutional Review Board. Academic tertiary infertility center. Seventy-five women with hysterosalpingographic and laparoscopic evidence of endotubal disease had 112 tubes available for falloposcopic evaluation. Diagnostic and operative falloposcopy was performed, when indicated, using aquadissection, flexible wire cannulation, or direct balloon tuboplasty. The endotubal lumens were considered to be falloposcopically normal in 52 tubes (46%), to contain mild to moderate disease in 33 (29%), and severe to obstructive disease in 27 (25%) cases. Within a year of the procedure, 6 of the 28 women (21%) in whom at least 1 tube was normal conceived, in 2 of 22 (9%) with mild to moderate disease, and in 0 of 16 (0%) with severe endotubal disease. Falloposcopy provides a visual means of scoring endotubal disease and may be intrinsically therapeutic for dislodging intraluminal debris and breaking down filmy adhesions in normal or minimally diseased tubes. The presence of severe disease remains resistant to the use of current endotuboplasty treatments as reflected by poor pregnancy outcome, and such women should be provided the option of microsurgical tubal repair or in vitro fertilization and embryo transfer procedures.

Transcervical Balloon Tuboplasty

Transcervical balloon tuboplasty represents a noninvasive technique to treat proximal tubal occlusion. In a multicenter study, 77 women with confirmed bilateral proximal tubal occlusion underwent the procedure. In 71 patients (92%), at least one proximally obstructed fallopian tube was recanalized. Concomitant distal bilateral tubal occlusions were diagnosed after successful proximal tubal balloon recanalizations in 13 patients (17%). In the remaining 64 patients, 22 clinical pregnancies (34%) have been confirmed during a median follow-up period of 12 months. Among those, 17 (77%) resulted in normal deliveries and five (23%) resulted in a first-trimester miscarriage. One patient was diagnosed with an ectopic pregnancy. Among 25 patients who had not conceived within 6 months of the procedure, 17 (68%) demonstrated continuing tubal patency on repeated hysterosalpingogram. We conclude that transcervical balloon tuboplasty is a safe outpatient technique that may represent an alternative to in vitro fertilization or microsurgical reanastomosis of fallopian tubes. ( JAMA . 1990;264:2079-2082)