Stricture Diameter Research Articles

Importance of endoscopically visualized recurrent ileitis and small-bowel resection for symptoms in Crohn's disease.

The relationship between the endoscopic appearance of the ileal mucosa in Crohn's disease and the symptoms has not been studied. Although surgery is important, morbidity caused by intestinal resections and its relation to recurrent inflammation have been poorly evaluated. The relationship of symptoms to various ileoscopic signs of inflammation and previous intestinal resection was prospectively studied in 75 postresection Crohn patients. Multivariate analysis showed that a combination of anastomotic width, pus, and length of previous small-bowel resection best explained a symptom score (r = 0.53, p < 0.001). Of 40 patients with the anastomosis strictured to less than 15 mm, only 9 had moderate to severe symptoms. Patients with a stricture diameter < 10 mm differed significantly in symptom score (p < 0.05) from those with wider anastomoses. The study indicated that intestinal resection was as important for symptoms as endoscopically viewed recurrent ileal inflammation. The diameter at which an intestinal stricture produces symptoms is less than previously argued, and the association of small-bowel resection with symptoms underlines the advisability of minimal surgery.

Balloon or bougie for dilatation of benign esophageal structure?

Ninety-three adult patients with benign esophageal stricture were randomized to receive balloon or bougie dilatation. Eighty-five patients were eligible for analysis and were followed prospectively for a year. Twenty-four patients required repeat dilatation within a year, but 50 patients completed a year's follow-up without further dilatation. The bougie group initially had a better symptomatic result, experiencing significantly less dysphagia at five months, although this difference had disappeared at one year. Eighteen patients in the balloon group required redilatation for symptoms compared with six in the bougie group. The bougie group had a significantly greater increase in their stricture diameter, and this was still present at one year after dilatation. There was no significant difference in safety or patient acceptability. Balloons are probably more costly to use than bougies. Bougie dilatation is to be preferred to balloon dilatation in adults except in special circumstances.

Oesophagitis is as important as oesophageal stricture diameter in determining dysphagia.

It is a common observation that stricture patients with severe dysphagia may have a wide lumen, while others with a narrow stricture have few swallowing complaints. In 64 patients with benign oesophageal stricture the dysphagia score (determined by questionnaire and by a test meal both based on nine different items of food scored according to their solidity) was compared with the diameter of the stricture measured radiologically by premeasured barium spheres. There was evidence of an association, but the correlation coefficient (r) was 0.544 (p = 0.0001), suggesting that the diameter of the stricture is an important, although not the sole, determinant of dysphagia. Stricture diameter explains 29.6% (r2) of variation in dysphagia score. The patients (mean dysphagia score 71 of a maximum possible 90) were divided into three groups according to the severity of oesophagitis (19 patients had minimal, 22 moderate and 23 severe oesophagitis). Analysis revealed the mean dysphagia score to be 83, 73, 59 in each group respectively. Dysphagia score of each group was significantly different from the others (Kruskal-Wallis test). Relating the dysphagia score to stricture diameter for each group gives correlation coefficient r = 0.379 (p = 0.110) in the minimal oesophagitis group, r = 0.651 (p = 0.001) in the moderate group, r = 0.583 (p = 0.004) in the severe group. If both diameter and severity of oesophagitis are included then 66.0% of the variation can be explained. It is concluded that the degree of oesophagitis is as important as luminal diameter in determining swallowing ability.

Effect of dilatation of peptic esophageal strictures on gastroesophageal reflux, dysphagia, and stricture diameter.

In 10 patients with peptic esophageal stricture the effect of esophageal dilatation on intraesophageal pH, stricture diameter, and dysphagia has been studied. Percentage of time during which intraesophageal pH was less than 4 and the number of reflux episodes per hour did not change significantly. Stricture diameter increased slightly, but consistently, from 7.0 +/- 0.5 mm to 9.1 +/- 0.5 mm (P less than 0.01) four days after dilatation, but was not significantly different from predilatation values after 12 weeks. Improvement in symptoms of dysphagia was striking (P less than 0.01) four days and six weeks after dilatation, but worsened again at 12 weeks (P = NS). It is unlikely that esophageal dilatation adversely affects the intraesophageal environment.

Radiologically guided balloon dilation of gastrointestinal strictures. Part I. Technique and factors influencing procedural success.

Radiologically guided balloon catheters were used to dilate 94 gastrointestinal strictures in 92 patients over a 6-year period. Fifty strictures were esophageal and 44 nonesophageal (22 gastroenterostomies, 11 antral-pyloric strictures, four colorectal strictures, four enteroenterostomies, and three miscellaneous strictures). Factors influencing the success of stricture intubation included patient age, stricture location (esophageal vs. nonesophageal and proximal vs. distal esophageal), and association with a surgical anastomosis. Malignancy was associated with greater postdilation irregularity and a smaller increase in stricture diameter, as measured radiographically. Procedural failures occurred in 8% of cases (2% of esophageal and 30% of nonesophageal lesions). Two small, asymptomatic mucosal tears were seen after dilation (one esophageal and one colonic); no other procedural complications occurred. Following successful dilation, 16 patients (17%; six with esophageal and ten with non-esophageal strictures) had recurrence of symptoms during short-term (30-day) follow-up.

Balloon dilatation of benign and malignant esophageal strictures: Blind retrograde balloon dilatation

Balloon esophageal dilatation offers many theoretical advantages (safety, speed, and patient comfort) over dilatation with mercury-filled bougies or with the Eder-Puestow system. The authors used balloon dilators in 22 patients with dysphagia secondary to benign or malignant strictures. Dilatation was performed with fluoroscopic guidance, blindly, or by a combination of these techniques. For "blind" stricture dilatation, an Eder-Puestow spring-tipped guide wire is placed into the stomach using a fiberoptic endoscope. The distance from the incisor teeth to the stricture is measured, and the balloon shaft is marked to indicate when the middle of the balloon is within the stricture. Dilatation is then performed using the antegrade or, the preferred, retrograde technique. Finally, the dilated stricture is calibrated by pulling an inflated balloon through the previously strictured area without difficulty. An attempt was made to achieve an esophageal diameter of 15 mm at the initial dilatation episode, and patient discomfort was used as a guide as to the final diameter. The balloon dilatation technique was highly successful, and a stricture diameter of 15 mm (45-47 French) was achieved at the initial dilatation in most instances. Malignant strictures were easily dilated. Balloon dilatation is convenient, effective, quick, and potentially safer than the previous Eder-Puestow or mercury-filled bougie techniques.

Functional evaluation of anterior urethral strictures with combined antegrade and retrograde urethrography.

The merits of radiological examination for functional evaluation of urethral strictures of the anterior male urethra were studied by comparing the results of combined retro- and antegrade urethrography with the patient's maximum urinary flow-rate. A correlation was found between stricture diameter and maximum flow-rate (r=0.67) and a still higher correlation between the ratio stricture diameter-prestenotic urethral diameter and the flow-rate (r=0.73). A low but significant (p less than 0.05) negative correlation was obtained between the prestenotic urethral diameter and the flow-rate (r=0.25).

The radiological measurement of oesophageal stricture diameter

A radiographic method of measuring the diameter of oesophageal strictures is described. Both a liquid bolus and a solid sphere were used. The measurements obtained were compared with measurements obtained at endoscopy. It is suggested that the most effective method is to determine the maximum size of barium sphere which will pass through a stricture.

Comparison of endoscopy and barium swallow in the diagnosis of esophageal stricture

The diagnostic accuracy of the barium swallow was determined in 109 patients with endoscopically proven esophageal strictures. In 73 (67%) the radiographic findings allowed the pre-endoscopic diagnosis of esophageal stricture. As expected, the radiographic accuracy was inversely related to the diameter of stricture: 10 mm or wider, 47%, 6 to 9 mm, 67%, and 5 mm or less, 92%.