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Effectiveness of Balloon Dilation in Corrosive Esophageal Strictures

April 10, 2009
Written by: , Filed in: Interventional Radiology
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A recent study was conducted to evaluate the long-term results of treatment of corrosive esophageal strictures by balloon dilation and to identify prognostic factors related to clinical outcome.

The study, published in the Journal of Vascular and Interventional Radiology, concluded that balloon dilation for corrosive esophageal strictures is effective therapy with low incidence of symptomatic rupture. It is not effective in patients in the early chronic phase or patients with resistant stenoses in the late chronic phase.

The Study
The study was a retrospective chart and radiological study review.

Methodology
Patient’s age, corrosive agent, and the interval between ingestion and stricture formation were evaluated.

The results after dilation were evaluated on the basis of technical success, clinical success, recurrence rate, primary and secondary patency, and the incidence of complications.

All strictures suspicious for malignancy were excluded from the study.

Clinical success was defined as patient food intake capacity before and 1 month after treatment on a 4-point scale:

  1. patient able to eat solid foods;
  2. patient able to tolerate soft foods;
  3. patient able to ingest liquids;
  4. aphagia.

Low-pressure inflation (hand inflation) of a 6 mm to 12 mm balloon left inflated for 1 to 2 minutes, and repeated 2 to 3 times, was performed.

If the stenosis was compliant and there was no evidence of rupture, the size of the balloon was increased to 20 mm. If the stenosis was resistant, further inflation was performed several days after.

After each dilation, contrast esophagram was used to check for rupture. Follow-up esophageal swallow was performed in 1 month, and patients were checked for recurrence by phone call every 6 months.

Interventional Radiology Review
 University of California San Francisco Department of Radiology
  Interventional Radiology Review is an excellent program to view a wide variety of unknown cases. Topics covered include Vascular Interventions and Non Vascular interventions such as:
 
 • Evaluation of Vascular Trauma
 • Arterial and Venous Catheter Angiography
 • Magnetic Resonance Angiography
 • Cholangiography
 • Chest Interventions
 • Nephrostomy and Ureteral Stents
 
  Earn up to 26 AMA PRA Category 1 Credits™.  
  Click here to read more or order: Interventional Radiology Review

Results
The researchers did a retrospective review of their records and images and identified 117 patients that received balloon dilation as treatment for esophageal strictures between 1987 and 2006. There were 47 males and 76 females (mean age, 45 years).

The average interval from ingestion to the first trial of balloon dilation was 9.5 years. There were 47 patients seen in the early chronic stage (<6 months after ingestion) and 70 in the late chronic stage (>6 months after ingestion). They achieved technical success 100% of the time, which was defined as increasing esophageal luminal diameter.

Mean stricture diameters were 4.3 mm prior to dilation and 11.4 mm after balloon dilation. Clinical success was achieved in 46% of patients, where food intake capacity scores improved by at least 1 point after 1 month.

Conclusions
Balloon dilation has a low complication rate and is a valuable initial therapy in those with corrosive esophageal stricture. However, it has a high recurrence rate with early chronic stage stricture and resistance to dilation in the late chronic stage.

Patients prone to stricture recurrence would benefit from a combination of balloon dilation and temporary stent placement.

Reviewer’s Comments

These results were conclusive, and suggest when patients may need stent placement or surgical intervention rather than balloon dilation, when they are in the early chronic phase, and only in the late chronic phase when the stenoses are resistant.

Author: Sharon Gonzales, MD

Reference:

Kim JH, Song HY, et al. Corrosive Esophageal Strictures: Long-term Effectiveness of Balloon Dilation in 117 Patients. J Vasc Interv Radiol; 2008; 19 (May): 736-741

Interventional Radiology Review
 University of California San Francisco Department of Radiology
  Interventional Radiology Review is an excellent program to view a wide variety of unknown cases. Topics covered include Vascular Interventions and Non Vascular interventions such as:
 
 • Evaluation of Vascular Trauma
 • Arterial and Venous Catheter Angiography
 • Magnetic Resonance Angiography
 • Cholangiography
 • Chest Interventions
 • Nephrostomy and Ureteral Stents
 
  Earn up to 26 AMA PRA Category 1 Credits™.  
  Click here to read more or order: Interventional Radiology Review
.

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