Early symptomatic strictures after gastric surgery: palliation with balloon dilation and stent placement.
OBJECTIVE
To evaluate the clinical efficacy and safety of balloon dilation and stent placement in the treatment of early benign anastomotic strictures after gastric surgery.


METHODS
From 1997 to 2006, 63 patients with early (< or =3 months) benign anastomotic strictures after gastric surgery underwent fluoroscopic balloon dilation or stent placement due to obstructive symptoms. In all patients, balloon dilation was initially performed. Stent placement was indicated in patients who showed poor response to repeat balloon dilation.


RESULTS
Balloon dilations were successfully performed in all 63 patients, with only three intramural tears. Thirty-one of the 63 patients (49%) showed good response to initial balloon dilation and required no further treatment until the end of follow-up or death. Conversely, 32 patients (51%) had poor or no response or recurrence after initial balloon dilation and required multiple balloon dilations (n = 20), stent placement (n = 7), percutaneous gastrojejunostomy (n = 2), and/or surgical revision (n = 3). At multivariate analysis, the anastomotic site was the only independent factor predictive of the response to balloon therapy (P < .001). During a mean follow-up of 12 months, overall clinical success was achieved in 56 of the 63 patients (89%) after a single balloon dilation (n = 31), multiple balloon dilations (n = 20), and stent placement (n = 5).


CONCLUSIONS
Balloon dilation is safe and effective for the treatment of patients with early benign anastomotic strictures after gastric surgery. Stent placement can be effective in selected patients with early benign anastomotic strictures refractory to balloon dilation.
Kim
Jin Hyoung
JH
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap-2dong, Songpa-gu, Seoul 138-736, Republic of Korea.
Song
Ho-Young
HY
Park
Sang Woo
SW
Yoon
Chang Jin
CJ
Shin
Ji Hoon
JH
Yook
Jeong Hwan
JH
Kim
Byung Sik
BS
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D002404:Catheterization; D016009:Chi-Square Distribution; D003251:Constriction, Pathologic / Q000628:therapy; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011183:Postoperative Complications / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents; D013270:Stomach / Q000601:surgery*; D016896:Treatment Outcome