Fluoroscopically guided balloon dilation for benign anastomotic stricture after Ivor-Lewis esophagectomy: experience in 62 patients.
OBJECTIVE
To evaluate the safety and clinical effectiveness of fluoroscopically guided balloon dilation in 62 patients with benign anastomotic stricture after Ivor-Lewis esophagectomy.


METHODS
Between January 1996 and June 2004, fluoroscopically guided balloon dilation was undertaken in 62 patients with benign anastomotic stricture after Ivor-Lewis esophagectomy. Radiologic images and medical records including complications were retrospectively reviewed. The maximum diameters of the balloon catheters used were 18-20 mm. Clinical success was defined by the absence of recurrent dysphagia after balloon dilation until the most recent follow-up. The Fisher exact test was used to assess the relationship of symptomatic recurrence and the balloon size, width of the stricture, and radiation therapy.


RESULTS
There were 115 sessions of balloon dilation in 62 patients (mean, 1.85 sessions per patient). Clinical success was achieved in 59 patients (95%) by means of a single dilation (n = 29) or by multiple dilations (n = 30). One patient with severe stenosis was successfully treated with temporary placement of a covered retrievable stent. Major complications such as esophageal perforation or massive bleeding did not occur. Four patients with mucosal tear (n = 3) or aspiration pneumonia (n = 1) were conservatively treated. Patients with severe stricture had more symptomatic recurrences than those with moderate stricture.


CONCLUSIONS
Fluoroscopically guided balloon dilation is a safe and successful treatment modality for benign anastomotic stricture after Ivor-Lewis esophagectomy.
Kim
Hyo-Cheol
HC
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea.
Shin
Ji Hoon
JH
Song
Ho-Young
HY
Park
Seung-Il
SI
Ko
Gi-Young
GY
Youn
Hyun-Ki
HK
Sung
Kyu-Bo
KB
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D002404:Catheterization / Q000379:methods*; D004940:Esophageal Stenosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D016629:Esophagectomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome