Single Balloon Research Articles

Single Balloon Enteroscopy: A Diversity of Patients, Diagnoses, and Therapeutics - The Bellevue Hospital Experience (2008-2015)

Introduction: Single balloon enteroscopy (SBE) is a method used for evaluation of the small intestine. It is most frequently used to investigate the cause of obscure gastrointestinal (GI) bleeding, and is useful to investigate other disorders as well. In a case series of obscure overt GI bleeding, Pinto-Pais et al. demonstrated that 93.3% of patients with active bleeding underwent SBE that identified the source, and 64.3% of patients with inactive GI bleeding had a definitive bleeding source identified. The aim of our study was to evaluate the efficacy of SBE at Bellevue Hospital from its introduction at our institution in 2008 through 2015. Methods: A query of our endoscopic software was performed of SBE procedures from January 2008 through September 2015. The main inclusion criterion was patients at least 18 years of age who underwent SBE. The patient's age, past medical history, pertinent laboratory tests, procedural indications, capsule endoscopy findings, pathology results, SBE outcomes, and adverse events were collected. Results: Forty SBEs were performed during this period: twenty-nine anterograde and eleven retrograde. The average age of the patients was 51.9. Procedural indications including bleeding (18), anemia (9), retained video capsule (4), intussusception (2), mass (2), and other abnormal imaging findings (5). Nineteen procedures were successful in reaching the area in question. Diagnoses included one paraganglioma, one adenocarcinoma, one GIST, and one carcinoid. Six procedures led to treatment of AVMs with subsequent improvement in anemia. Adverse events included abdominal pain in 3 procedures. Two of these episodes resolved without intervention and the third patient was lost to follow-up. One patient had mucosal trauma and oozing. One patient had melena and a decline in hemoglobin, which resolved without intervention. One patient had a possible retroperitoneal hematoma after the procedure. Conclusion: This study outlines the diagnostic and therapeutic utility of SBE in varied clinical scenarios in the diverse patient population at Bellevue Hospital, a large tertiary care referral center in New York City. Ongoing studies would include investigating the utility of SBE in symptomatic patients without abnormal findings on imaging or laboratory studies, the use of enteroscopic localization technology to improve patient comfort, safety, and procedural efficiency, and optimizing procedural timing to determine if sensitivity and yield are enhanced.Figure: A) 73-year-old patient with obscure occult and overt GIB with video capsule endoscopy (VCE) showing blood and angioectasias. Anterograde SBE to distal jejunum showing a single non-bleeding angioectasia treated with APC. B) 78-year-old patient presented with IDA and jejunal tumor on CT. Anterograde SBE to the mid/distal jejunum showing large circumferential friable area of necrotic mucosa with overlying clot. Biopsies revealed paraganglioma, successfully managed surgically. C) 26-year-old patient with recurrent episodes of abdominal pain and intussusception. VCE demonstrated small bowel polyposis. Anterograde SBE to mid/distal jejunum demonstrated a 15mm polyp, successfully managed with saline lift-assisted polypectomy. D) 61-year-old patient with a history of colon cancer who presented with melena, IDA, and abnormal CT scan. Anterograde SBE to mid/distal jejunum revealed 5cm lesion in the third part of the duodenum, biopsies revealed invasive adenocarcinoma.

Jejunal Lymphangiectasia as Source of Obscure Gastrointestinal Bleed (GIB) and Its Endoscopic Management

Intestinal lymphangiectasia is a pathologic dilatation of the intestinal lymphatic vessels in the mucosal and sub-mucosal layers of the gastrointestinal tract. Protein loosing enteropathy is a common presentation, gastrointestinal bleeding is unusual. A 36-year-old woman with a history of gastroesophageal reflux disease was evaluated for a 3-month history of melena, 20 lb. weight loss, and fatigue. Physical examination revealed generalized pallor and mild non-rebound tenderness in the left upper quadrant. Laboratory data revealed macrocytic anemia with hemoglobin (Hgb) of 5.7 g/dl, MCV of 106 and reticulocyte count of 12.9%. Iron studies revealed iron deficiency anemia and anemia of chronic disease. Celiac panel was unremarkable. She refused blood transfusions due to religious beliefs. Given the presence of anemia, the patient underwent esophagogastroscopy and colonoscopy, both were unremarkable. She was started on subcutaneous darbepoetin and intravenous iron which initially improved her Hb to 7.0 g/dl but her fatigue and melena recurred. Capsule endoscopy showed mucosal changes compatible with lymphangiectasia with multiple areas of active bleeding with clots within the first two hours of the capsule endoscopy. Single balloon enteroscopy showed a 10-cm segment of extensive whitish linear plaques with polypoidal areas with slow oozing of blood in the proximal jejunum (Figure 1). Argon plasma coagulation (Figure 2) was used to achieve hemostasis successfully. Biopsy from the polypoidal whitish plaques were consistent with lymphangiectasia (Figure 3). Post procedure, her melena resolved and Hgb improved to 11.1g/dl with intravenous iron. Intestinal lymphangiectasia presenting with isolated GI bleed is very rare. Only a few case reports have been reported in the literature. To our knowledge, this is the first case reported in literature using APC as a treatment modality for actively bleeding biopsy proven lymphangiectasia.Figure: Jejunal lymphangiectasia with active bleeding.Figure: Argon plasma coagulation used to achieve hemostasis in jejunal lymphangiectasia.Figure: Jejunal mucosa with dilated lymphatic channels in lamina propria filled with protein-rich fluid.

An Unusual Case of Late Metastasis to Jejunum From Previously Resected Colon Cancer Mass

Distant metastasis of colorectal cancer (CRC) to unusual sites, like small bowel, kidney, thyroid many years after resection of the primary tumor is rare but has been reported. A 71-year old female with a history of Stage IIIb CRC status post resection 2 years ago presented with worsening dyspnea, fatigue and post-prandial lower abdominal pain for 2 weeks. Her other medical conditions include coronary artery disease, pulmonary hypertension and atrial fibrillation on anticoagulation therapy. She denied any nausea, vomiting, bright red blood per rectum, NSAID's use or epigastric pain. Her abdominal exam was benign except for dark stool on rectal exam. Labs showed iron deficiency anemia and positive fecal occult blood. She underwent capsule endoscopy which showed a ulcerated area in the proximal small bowel with oozing blood and irregular mucosa. Eventually, she underwent single balloon enteroscopy which showed an ulcerated, friable mass in the mid-distal jejunum. Biopsies showed moderately differentiated adenocarcinoma and positive anti-CK 20, similar to her primary sigmoid lesion, confirming the diagnosis of metastasis from CRC. The incidence of CRC metastases to the small bowel is relatively rare, about 2.8-8.2%. The most common site is ileum, followed by jejunum. A significant lag time of 1.3-7 years, from the initial diagnosis of colorectal cancer to the onset of symptomatic small bowel metastasis, has been reported. The routes of metastasis to the small intestine include hematogenous, peritoneal or intestinal metastasis. The major route from CRC is, disseminated metastasis associated with peritonitis carcinomatosa. Patients may present with symptoms such as occult bleeding, intestinal obstruction, or perforation. The diagnosis is often made on a small bowel series or CT. However, neither can differentiate a primary from a metastatic small bowel cancer. Radical surgical resection of such late metastasis is reportedly associated with a good quality of life but postoperative complication rates are high, about 80% and survival is short (2-15 months), although survival up to 11 years has been reported. Our case highlights the late occurrence of CRC metastases at unusual sites like small bowel, several years after the resection of the primary. It should be suspected in any patient with occult GI bleeding and history of CRC. Diagnosis is based on capsule endoscopy for tumor localization and balloon-assisted enteroscopy for confirmation.

A Comparison of SIF-Q180 versus SIF-Y0005 Single Balloon Enteroscopes

Introduction: Single Balloon Enteroscopy (SBE) is an important tool in the evaluation and management of small-bowel disease. An enteroscope not yet released by Olympus, the SIF-Y0005, displays a unique combination of two proprietary technologies: passive bending and high force transmission. Cumulatively, this may improve ease of insertion, operator control, and enhance procedural efficiency. In addition, it has a 3.2mm biopsy channel to facilitate instrument insertion. We aimed to evaluate the diagnostic and therapeutic yields, and insertion depth between the prototype and the SIF-180 enteroscope.Table: No Caption available.Table: No Caption available.Table: No Caption available.Methods: A retrospective cohort study of 65 patients undergoing SBE was performed at Tampa General Hospital. Patients were divided into two groups: 39 patients undergoing SBE with the SIF-Q180 (control) vs. 26 with the SIF-Y0005 (prototype). Data on patient demographics, diagnostic yield, therapeutic yield, and insertion depth were compared between groups. The difference for categorical variables was assessed using a X2 test and summarized as odds ratio (OR) with 95% confidence intervals (CI). The difference for continuous variable was assessed using independent samples t-test and summarized as mean difference along with 95% CI. To adjust for multiple comparison, Bonferroni correction was applied. The statistical significance was set at 5% for all comparisons. Results: 54 patients underwent anterograde enteroscopy: 18 patients using the prototype enteroscope vs. 36 using the control. 11 patients underwent retrograde enteroscopy: 8 patients using the prototype enteroscope vs. 3 using the control (p=0.036). The diagnostic yield was higher using the prototype enteroscope, with a 2.1 greater odds of finding an abnormality than when using the control enteroscope, but this did not reach statistical significance [OR 2.1 (0.64-6.84);p=0.336]. Therapeutic yield was found to be higher using the prototype enteroscope, with a 1.45 greater odds of treatment performed, but this did not reach statistical significance, [OR 1.45 (0.53-3.91);p-0.647]. The prototype enteroscope had a further insertion depth, however, this did not reach statistical significance [0.58 (-40.892 - 46.048); p=0.906]. Suc cess rate intubating the ileum and performance of retrograde enteroscopy was 100% with the prototype enteroscope. Conclusion: The prototype enteroscope had better diagnostic and therapeutic yields, and insertion depth, although not reaching statistical significance, which was most likely due to small sample size.

Jejunojejunostomy Intussusception After Roux-en-Y Gastric Bypass: Do We Need to Treat?

Jejunojejunostomy (J-J) intussusception is a rare complication that occurs in 0.4% of patient after Roux-en-Y gastric bypass (RYGB). Although reduction or resection with revision of the area of intussusception appears to be effective, in less acute patients, the best treatment options are controversial. Here, we present a rare case of jejunojejunostomy intussusception after Roux-en-Y gastric bypass that resolved after single balloon enteroscopy. A 30-year-old female patient presented to our facility with left upper quadrant abdominal pain of few days duration associated with nausea and vomiting. Past history was significant for partial gastrectomy, Roux-en-Y gastric bypass surgery of 10 years duration, and multiple other abdominal surgeries for enterocutanous fistula. On admission, her vitals were stable, and abdominal exam showed soft, non-distended abdomen with tenderness at the left upper quadrant, with no peritoneal signs. Complete blood count, lipase, and lactate were normal. Serum electrolytes were significant for hypokalemia secondary to vomiting. Computed tomography (CT) scan of the abdomen showed J-J intussusception at the Roux-en-Y anastomosis (Image 1). She was scheduled for a single balloon enteroscopy for further evaluation. Endoscopic examination showed no evidence of intussusception or any obstruction of anastomosis sites and limbs. The patient tolerated the procedure well without complications. After the procedure, the patient underwent a follow up CT of abdomen and pelvis that showed no residual intussusception. Although her intussusception might be resolved with air insufflation during the single balloon enteroscopy, spontaneous resolution might be another possibility. On hospital day 3, the patient was tolerating a regular diet and her symptoms completely resolved. Jejunojejunostomy intussusception after Roux-en-Y gastric bypass is uncommon, and might resolve with a single balloon enteroscopy or spontaneously. Watchful waiting could be an appropriate option in less acute cases.Figure: Image 1: IV Contrast enhanced Axial (A) and coronal (B) computed tomography (CT) of the abdomen demonstrating intussusception at the Roux-en-Y anastomosis (red arrow).

Therapeutic peroral direct cholangioscopy using a single balloon enteroscope in patients with Roux-en-Y anastomosis (with videos).

Peroral cholangioscopic lithotripsy is a useful procedure in patients with a normal gastrointestinal anatomy who have difficult-to-treat stones. We evaluated the usefulness of peroral direct cholangioscopy (PDCS) using single-balloon enteroscope (SBE) in patients with difficult-to-treat stones who had undergone Roux-en-Y reconstruction. Among 118 patients (169 sessions) who underwent SBE-assisted endoscopic retrograde cholangiopancreatography to treat biliary stones after Roux-en-Y reconstruction, patients in whom it was difficult to remove biliary stones via a transpapillary or transanastomotic approach and difficult to switch to ultra-slim endoscope, were retrospectively enrolled. The biliary insertion success rate, procedure success rate, procedure time, and procedural complications were assessed. The SBE was inserted into the bile-duct, first using a free-hand technique, second using a guide wire, and third using the large balloon anchoring and deflation (LBAD) technique. A total of 11 patients (14 sessions) were enrolled in this study. The biliary insertion success rate was 100%. Bile-duct insertion was performed using a free-hand technique in 4 sessions, a guide wire in 3 sessions (rendezvous technique, 2 sessions), and the LBAD technique in 7 sessions. The procedure success rate was 86% in first session, and 100% in second session. The median procedure time was 81min (range 49-137). The median procedure time in the bile-duct was 21.5min (range 6-60). Mild pancreatitis occurred as a complication in one patient. The median follow-up was 528days (range 282-764). No patient had stone recurrence. PDCS using SBE is a useful procedure in patients with Roux-en-Y reconstruction. The LBAD technique is an useful technique of inserting SBE into the bile-duct.

Success of Percutaneous Endoscopic Gastrostomy by Single Balloon Enteroscopy in Patients Who Have Undergone Roux-en-Y Gastric Bypass.

Data is limited regarding the success and safety of percutaneous endoscopic gastrostomy (PEG) placements by single balloon enteroscopy (SBE) in patients with Roux-en-Y gastric bypass (RNY-GB) anatomy. We report on 23 cases of PEG placements by SBE with overall technical success of reaching the excluded stomach 70% and with PEG placement success rate of 69%. No intra-procedural adverse events occurred. This technique seems safe when feasible for PEG placement in patients with RNY-GB anatomy.

Study of high energy phenomena from near space using low-cost meteorological balloons

Indian Centre for Space Physics has taken a novel strategy to study low energy cosmic rays and astrophysical X-ray sources which involve very light weight payloads up to about five kilograms on board a single or multiple balloons which are usually used for meteorological purposes. The mission duration could be anywhere from 3-12 hours. Our strategy provides extreme flexibility in mission preparation and its operation using a very economical budget. There are several limitations but our innovative approach has been able to extract significant amount of scientific data out of these missions. So far, over one hundred missions have been completed by us to near space and a wealth of data has been collected. The payloads are recovered and are used again. Scientific data is stored on board computer and the atmospheric data or payload location is sent to ground in real time. Since each mission is different, we present here the general strategy for a typical payload and provide some results we obtained in some of these missions.

Mo1195 A Novel Method for Peg-J Tube Insertion Using Single Balloon Enteroscopy and the Wedge Technique

Mo1195 A Novel Method for Peg-J Tube Insertion Using Single Balloon Enteroscopy and the Wedge Technique

Loop Recorder Detected High Rate of Atrial Fibrillation Recurrence after a Single Balloon- or Basket-Based Ablation of Paroxysmal Atrial Fibrillation: Results of the MACPAF Study.

Pulmonary vein isolation (PVI) is an established approach to treat symptomatic non-permanent atrial fibrillation (AF). Detecting AF recurrence after PVI is important, if discontinuation of oral anticoagulation after ablation is considered. Patients with symptomatic paroxysmal AF were enrolled in the prospective randomized mesh ablator vs. cryoballoon pulmonary vein (PV) ablation of symptomatic paroxysmal AF study, comparing efficacy and safety of the HD Mesh Ablator® (C.R. Bard, Lowell, MA, USA) and the Arctic Front® (Medtronic, Minneapolis, MN, USA) catheter. Rhythm status post-PVI was closely monitored for 1 year using the implantable loop recorder (ILR) Reveal XT® (Medtronic Minneapolis, MN, USA). The study was terminated after the first interim analysis due to the inability of the HD Mesh Ablator® to achieve the predefined primary study endpoint, an exit block of all PVs. After a 90-day blanking period, 23 (62.2%) out of 37 study patients (median 63.0 years; 41% females) had at least one episode of AF. AF recurrence was associated with AF episodes during the blanking period {hazard ratios (HR) 5.10 [95% confidence interval (CI) 1.21-21.4]; p = 0.038}, and a common left-sided PV ostium [HR 4.17 (95%CI 1.48-11.8); p = 0.039] but not with catheter type, age, gender, cardiovascular risk profile, or left atrial volume. There was a trend toward AF recurrence in patients without complete PVI of all PV (p = 0.095). Overall, 337 (59.4%) out of 566 ILR-detected episodes represented AF. Comparing patients with AF recurrence to those without, there was no difference in cognitive performance 6 months post-ablation. Using an ILR, in more than 60% of all patients with paroxysmal AF, a recurrence of AF was detected within 12 months after ablation. In patients with a common PV ostium, the first generation balloon-based catheter is obviously less effective. http://Clinicaltrials.gov NCT01061931.

Technical review of endoscopic ultrasonography-guided gastroenterostomy in 2017.

Gastric outlet obstruction (GOO) can be caused by benign and malignant diseases and often leads to a reduction in patient quality of life. Lately, endoscopic ultrasonography (EUS)-guided gastroenterostomy (EUS-GE) has emerged. At the present time, there are three types of EUS-GE using lumen-apposing biflanged metal stents (LAMS): (i) direct EUS-GE; (ii) assisted EUS-GE using retrieval/dilating balloon, single balloon overtube, nasobiliary drain and ultraslim endoscope; and (iii) EUS-guided double-balloon-occluded gastrojejunostomy bypass (EPASS). Overall technical success rate is approximately 90% regardless of technique used, although this is based on two retrospective studies only. In the EPASS procedure, the success rate of the one-step procedure was higher than that of the two-step procedure (100% vs 82%). Clinical success was almost uniform when stent placement was technically successful. Although there have been no-stent induced procedural deaths, adverse events were seen in several cases. One technically failed case carried out using balloon-assisted EUS-GE was converted to laparoscopic gastrojejunostomy. Two failed cases in EPASS procedure improved with conservative treatment. In the present review, we show the feasibility and outcomes using novel EUS-GE using LAMS. Clinical prospective trials with comparison to luminal enteral stents and surgical GE are warranted.

Complete Transcatheter Repair of Fallot’s Trilogy: A Case Report

Fallot’s trilogy is a relatively uncommon form of cyanotic congenital heart disease characterized by severe valvular pulmonary stenosis (PS), right ventricular hypertrophy and right to left interatrial shunt via an atrial septal defect (ASD) or patent foramen ovale (PFO). Historically, patients with the combination of these lesions were routinely treated by surgical correction. In recent times, transcatheter repair has become an increasingly attractive modality of treating such patients. There is limited experience with such combined transcatheter interventions, and from the scarce data available in published literature it seems that such approach has promising safety and efficacy. Herein, we describe a case of an 18 year old cyanotic male patient who was diagnosed of having severe valvular PS with supra systemic right ventricular pressures and reversed interatrial shunt via a large secundum ASD. We successfully treated him percutaneously with serial balloon pulmonary valvuloplasty, using single balloon and Inoue balloon techniques, followed by Amplatzer device closure of the ASD. The outcome was excellent with marked reduction of trans-pulmonary valvular gradient, complete cessation of shunting across the ASD, dramatic improvement of symptoms and completes disappearance of cyanosis. There were no procedure related complications and the benefits were sustained at follow up of three years. Our case demonstrates that transcatheter repair is a feasible, safe and effective alternative to surgery in selected patients with Fallot’s trilogy. With further experience, it may well become the standard of care in the management of such patients.

A Spiral Stomach after Vertical Sleeve Gastrectomy

Clinical Image: A patient presented with dysphagia and vomiting after undergoing a vertical sleeve gastrectomy, which was performed for surgical treatment of medically-complicated obesity. A barium gastrogram outlined a small, remaining proximal stomach (indicated by a small black arrow in Figure 1) connected to the gastric antrum (indicated by a large white arrow in Figure 1) by a spiral of gastric sleeve. At upper endoscopy, a guide wire was passed under fluoroscopic guidance through the gastric sleeve and into the antrum. A Boston Scientific controlled radial expansion (CRE) single use esophageal balloon dilator was passed over the guide wire under fluoroscopic guidance, and segmental balloon dilation of the gastric sleeve was then performed. After dilation of the gastric sleeve, the patient noted minimal residual dysphagia when eating solid foods and a repeat barium gastrogram revealed a straight gastric sleeve.

シングルバルーン内視鏡で診断しえた若年性小腸癌の1例

シングルバルーン内視鏡で診断しえた若年性小腸癌の1例

747: Double balloon is not superior to single balloon trans-cervical catheter for induction of labor: a meta-analysis

747: Double balloon is not superior to single balloon trans-cervical catheter for induction of labor: a meta-analysis

The "Dog Bone Technique" A Novel Easy and Safe Catheter Maneuver for Aortic Arch and Coarctation Stenting.

Various techniques are described to facilitate stable stent implantation in aortic arch stenosis or coarctation. We describe an alternative technique, which due to its unique appearance during stent implantation, we have named "Dog Bone Technique" (DBT). The stent/balloon assembly is placed across the stenosis, the long sheath is retrieved to uncover the distal 20-50% of the stent. The balloon is inflated with the pressure inflator just to expand slightly the stent. Thereafter the sheath is pulled back and the proximal end is uncovered and partially inflated; therewith the assembly takes the typical "dog bone" shape before complete inflation and final positioning. Repositioning of the stent and control angiography is possible at each time of this procedure. Between 1/2010 and 12/2014 we implanted 91 stents in 87 patients (mean age 20.2 years). About 71 patients had native or re-coarctation and 16 patients had transverse aortic arch stenosis. In 38 patients (44%) a pharmacological exercise test with Orciprenaline was performed during implantation resulting in high-cardiac output. In none of the patients reduction of cardiac output by adenosine or a rapid pacing of the right ventricle was required for stable stent implantation. All stents were implanted in the targeted position using this single balloon technique. There were no acute or short-term complications detected. DBT is a safe and feasible technique for aortic stent implantation even at high-cardiac output. Other additional techniques for stent placement are not necessary to obtain a stable final position in the target region.

Peutz-Jeghers Syndrome: Diagnostic and Therapeutic Possibilities of Modern Intraluminal Endoscopy as Shown on Own Clinical Observations

Peutz-Jeghers syndrome is a relatively rare autosomal-dominant inheritance type disease characterized by multiple hamartomas in the gastrointestinal tract. Treatment of such patients is traditionally surgical, but nowadays, due to the introduction of new methods of intraluminal endoscopy, it is often possible to avoid open abdominal operations, diagnose and remove the hamartomatous polyps in a minimally invasive way. The aim of this article is to demonstrate the diagnostic and surgical capabilities of modern intraluminal endoscopy for the treatment of patients with multiple hereditary gastrointestinal polyposis as shown on our own clinical observations. The technique of deep single balloon enteroscopy in conjunction with standard routine endoscopic manipulations allows to perform a total examination of the whole gastrointestinal tract and, if necessary, to remove almost all epithelial neoplasia, which certainly has a positive impact on the quality of the patient’s life.

PMD6 - A Health Technology Assessment of Single Balloon Valvuplasty

This HTA aims to evaluate the clinical effectiveness of Single Balloon Valvoloplasty in comparison to the Double Ballon Valvuloplasty in order to assess its results in patients suffering from Mitral Stenosis. Health technology assessment was conducted by systematically reviewing the published literature . An electronic literature search was performed in Cochrane, PubMed, Journal of the American College of Cardiology databases for randomized controlled trials. RevMan 5.3 was used for data analysis and quantitative data synthesis. Out of 78 studies which were screened, 15 studies were included in the quantitative analysis (meta-analysis). In comparison to the Double Balloon Valvuloplasty Single Balloon Valvuloplasty significantly reduced mortality by 17 % which is indicated by Risk Ratio (RR) 0.83 (95%CI, 0.38- 1.84). Single Balloon Valvuloplasty is found to be 4% more effective in reducing Mitral regurgitation Risk Ratio (RR)is 0.96(95%CI, 0.74- 1.23).Procedure failure with single balloon Valvoloplasty is less indicated by Risk Ratio (RR)0.98 (95%Cl ,0.89-1.07). Single Balloon Valvuloplasty is clinically effective as far as the outcomes pertaining to the Mortality,Mitral regurgitation and Procedure failure are concerned . The burden of Rhuematic Heart Disease which thereby results in Mitral Stenosis being high therefore Single Balloon Valvuloplasty can be a potent intervention.

Safety of interventional of high pressure balloon expansion catheter applicated in benign and malignant airway stenosis lesions treatment

Objective To explore the security and its influencing factors on benign airway stenosis treated with interventional of high pressure balloon expansion catheter. Methods Clinial data of 39 cases of inpatients suffered from benign airway stenosis were chosen.17 cases were male, and 22 cases were female.The ages of them ranged from 15 to 83 years old.According to the clinical symptoms, HRCT 3D reconstruction, and the results of bronchoscope, all patients were treated with balloon expansion catheter at different criterions.The balloon catheter with size that slightly smaller than the targeted normal bronchial tube was chosen, expansion for average 1-4 times, single balloon expansion time ranged from 0.5 to 4 min, the pressures were kept at 3-6 atmosphere, and the highest pressure did not exceed 8 atmospheric pressure.The efficacy and complications were retrospectively analyzed. Results 19 cases were completely effective, 14 cases were basically effective, 6 cases were completely ineffective, and the total effective rate was 84.6%(33/39), the incidence of complications was 35.8%(14/39), moreover, no deaths occurred. Conclusion High pressure balloon catheter expansion is one of commonly used technology in breathing interventional treatment; it has the characteristics of easy operation, and immediate curative effect, and so on.But if the improper operation, incorrect selection of the case, or inaccurate evaluation of the stenosis during operation, serious complications and unnecessary iatrogenic injury can be occurred.Therefore, it is worthy of attention and further summarizing by breathing interventional physicians. Key words: Tracheal stenosis; Saccule and utricle; Balloon dilation; Safety

Submitted, Not Presented: Clinical Vignettes/Case Reports - Small Intestine/Unclassified.

Hemangiomas of the small bowel are a rare phenomenon and usually present with gastrointestinal bleeding. They are defined as masses of capillaries and blood-filled endothelial-line spaces that rarely manifest in the small intestines. Most of them are symptomatic until they present with bleeding and anemia; and less commonly can cause intestinal obstruction, intussusception or perforation. Intestinal bleeding can be acute with severe, life threatening blood loss, or chronic with anemia. Initial work up includes upper and lower gastrointestinal endoscopy, barium contrast study and computed tomography (CT) scans. Further evaluation includes video capsule endoscopy, and deep enteroscopy. We present a case of a 59 year-old male with dizziness, fatigue and melena. He endorsed a history of blood in stools for the past eight months. The patient was not taking NSAIDs or on anticoagulation medications. In the two days before admission, his episodes of black stools have considerably increased. Recent GI work up included a normal esophagogastroduodenoscopy (EGD), anterograde enteroscopy to proximal ileum showing no acute pathology, colonoscopy which revealed small nonbleeding diverticula in the sigmoid colon, and video capsule endoscopy which showed evidence of bleeding in the mid-small bowel. The patient's vitals were stable and he was not orthostatic. Physical exam was unremarkable, rectal exam showed melena, laboratory studies revealed a drop of 2 grams of hemoglobin to 9 g/dL. Repeat video capsule endoscopy again showed evidence of active bleeding in mid-small bowel with an area of questionable ulceration versus ulcerated mass. CT enterography was unremarkable with no evidence of abnormal mass. The patient underwent antegrade single balloon enteroscopy which revealed a single 1-2 cm. vascular lesion suspicious for hemangioma that was actively oozing from a punctuate lesion on the surface. To control bleeding, initially a Gold Probe was employed that slowed but did not stop bleeding. An argon beam coagulator, set at 20 watts, was then use with complete control of bleeding. This area was tattooed proximally with a sclerotherapy needle using india ink. The patient's hemoglobin stabilized and melena resolved after procedure and he was discharged home. This case illustrates successful endoscopic therapy of an actively bleeding hemangioma at the time of deep enteroscopy with the single balloon enteroscope.