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Objectives: The purpose of this study is to investigate the incidence and management of oesophageal ruptures following fluoroscopic balloon dilatation (FBD) in children with benign oesophageal strictures., Methods: Sixty-two children with benign oesophageal strictures underwent FBDs. Oesophageal rupture was categorized as intramural (type 1), transmural (type 2), or transmural with free leakage (type 3). The possible risk factors for oesophageal ruptures were analyzed., Results: One hundred and twenty-nine FBDs were performed in these patients. The oesophageal rupture rate was 17.1 % (22/129). The majority (21/22) of ruptures were type 1 and type 2, both were treated conservatively. Only one patient had a type 3 rupture and underwent oesophagoesophagostomy. The patient gender, age, and the length and cause of the stricture showed no significant effect on the rupture (P > 0.05). However, for the patients ≤2 years old, the initial balloon with a diameter ≥10 mm showed a higher oesophageal rupture rate than those <10 mm during the first session (P = 0.03)., Conclusions: Although the oesophageal rupture rate in children was 17.1 %, the type 3 rupture rate was 0.8 %, which usually requires aggressive treatment. For children ≤2 years old, the initial balloon diameter should be <10 mm in the first session for decreasing the risk of oesophageal rupture., Key Points: • The oesophageal rupture rate following balloon dilatation in children was 17.1 %. • The incidence of transmural rupture with free leakage is very low. • Only transmural rupture with free leakage needs aggressive treatment. • For children ≤2 years, the initial balloon diameter should be <10 mm.

Purpose: Little was known about the safety and long-term efficacy of fluoroscopically guided balloon dilation for postintubation tracheal stenosis. The purpose of this study was to evaluate the safety and long-term efficacy of fluoroscopically guided balloon dilation in patients with postintubation tracheal stenosis., Methods: From February 2000 to November 2010, 14 patients underwent fluoroscopically guided balloon dilation for postintubation tracheal stenosis. Technical success, clinical success, and complications were evaluated. Patients were followed up for recurrent symptoms., Results: In all patients, fluoroscopically guided balloon dilation was technically and clinically successful with no major complications. Following the initial procedure, six patients (43 %) remained asymptomatic during a follow-up period. Obstructive symptoms recurred in eight patients (57 %) within 6 months (mean, 1.7 months), who were treated with repeat balloon dilation (n = 4) and other therapies. Of the four patients who underwent repeat balloon dilation, three became asymptomatic. One patient became asymptomatic after a third balloon dilation. On long-term (mean, 74 months) follow-up, 71 % of patients experienced relief of symptoms following fluoroscopically guided balloon dilation., Conclusions: Fluoroscopically guided balloon dilation may be safe, is easy to perform, and resulted in effective treatment in patients with postintubation tracheal stenosis.

Objective: The purpose of this article is to retrospectively evaluate the long-term clinical results of balloon dilation in the treatment of benign anastomotic strictures after esophagectomy and to identify factors associated with stricture recurrence., Materials and Methods: From January 1996 to June 2011, a total of 309 sessions of balloon dilation were performed in 155 patients with benign anastomotic strictures after esophagectomy. Long-term clinical effectiveness was assessed using the following variables: technical and clinical success, complications, and patency rates. Factors independently related to recurrence were evaluated with the Cox model. Tested variables were age, sex, operation type, postoperative anastomotic leakage, balloon size, length of stricture, time to postoperative stricture development, complications, and neoadjuvant chemoradiotherapy., Results: The mean follow-up period was 37 months (range, 1-159 months). Overall clinical success was achieved in 153 patients (99%) after a single (n = 78) or multiple (n = 75) balloon dilations. During follow-up, recurrence of the stricture requiring repeated dilation was seen in 77 of 155 patients (50%). Esophageal rupture (mostly intramural rupture) occurred in 22 of 155 patients (14%) and 34 of 309 balloon dilations (11%). In multivariate analysis, early development of stricture within 10 weeks after surgery (p = 0.002) and McKeown esophagectomy (p = 0.002) were independently related to recurrence after initial balloon dilation., Conclusion: Balloon dilation under fluoroscopic guidance has encouraging long-term results in the treatment of benign anastomotic strictures after esophagectomy. However, recurrence after balloon dilation was common, with McKeown esophagectomy and development of stricture within 10 weeks after surgery associated with recurrent strictures.

Purpose: To present a well-defined protocol for balloon dilation for colorectal anastomotic strictures and evaluate clinical efficacy of the dilation in 42 patients., Materials and Methods: From October 1999 to June 2010, 42 patients (32 males and 10 females with mean age 52.1 years ± 16.3) with surgical colorectal anastomotic strictures who received transanal balloon dilation using a well-defined protocol were retrospectively investigated. After the procedure, a water-soluble contrast media study was performed to detect possible complications. Stricture diameter was measured 1 month after balloon dilation. Clinical outcomes and recurrence were evaluated with a median follow-up period of 63.7 months., Results: There were 47 dilation sessions performed in 42 patients. Technical success and clinical success were achieved in all patients. At long-term follow-up, 36 (85.7%) patients had complete improvement. No complications were observed in any patients. Stricture diameter 1 month after the procedure was 8.85 cm ± 3.23, which was a significant increase over stricture diameter before the procedure of 5.89 cm ± 2.64 (P < .001), showing increase in diameter by 50.3%. Four (9.5%) patients experienced symptomatic recurrence. Stricture diameter of the patients with recurrence was considerably larger than stricture diameter of other patients (P = .036)., Conclusions: Fluoroscopically guided balloon dilation using the protocol described is safe and clinically effective for treatment of colorectal anastomotic stricture., (Copyright © 2012 SIR. Published by Elsevier Inc. All rights reserved.)

Objective: To assess the clinical efficacy of alternative techniques for biliary stricture cannulation in patients undergoing living donor liver transplantation (LDLT), after cannulation failure with a conventional (0.035-inch guidewire) technique., Subjects and Methods: Of 293 patients with biliary strictures after LDLT, 19 (6%) patients, 11 men and 8 women of mean age 48.5 years, had the failed cannulation of the stricture by conventional techniques. Recannulation was attempted by using two alternative methods, namely a micro-catheter set via percutaneous access and a snare (rendezvous) technique using percutaneous and endoscopic approaches., Results: Strictures were successfully cannulated in 16 (84%) of the 19 patients. A microcatheter set was used in 12 and a snare technique in four patients. Stricture cannulation failed in the remaining three patients, who finally underwent surgical revision., Conclusion: Most technical failures using a conventional technique for biliary stricture cannulation after LDLT can be overcome by using a microcatheter set or a snare (rendezvous) technique.

Objective: The objective of this study was to investigate the incidence of esophageal complications associated with balloon dilation and their management in patients with malignant esophageal strictures., Materials and Methods: Fluoroscopically guided esophageal balloon dilation was performed in 89 patients with malignant esophageal strictures during a period of 15 years. Inclusion criteria were patients with unresected esophageal or gastric carcinoma showing short-segment stricture (≤4 cm) at the esophagogastric junction; patients who had previously received chemotherapy, radiation therapy, or both to manage malignant strictures; or patients who were scheduled for chemotherapy or radiation therapy to manage malignant strictures. Of these patients, 72 had esophageal cancer and 17 had stomach cancer. Esophageal rupture was categorized as intramural, transmural, or transmural with mediastinal leakage., Results: A total of 120 procedures were performed, with each patient undergoing one to four procedures. Esophageal rupture occurred in 13 patients (15%): eight with intramural rupture, four with transmural rupture, and one with transmural rupture with mediastinal leakage. Improvements in dysphagia score were observed in 76 of 89 patients (85%) after balloon dilation. All esophageal ruptures were detected immediately after the procedure. Intramural and transmural ruptures were treated conservatively, whereas transmural rupture with mediastinal leakage was treated by temporary stent placement., Conclusion: The overall prevalence of esophageal rupture was 15%. All intramural and transmural ruptures were successfully managed conservatively, whereas transmural rupture with mediastinal leakage was treated by temporary stent placement. We found no relationship between rupture incidence and balloon diameter.

Objective: The purpose of this article is to investigate the incidence and management of esophageal rupture caused by balloon dilation in patients with benign esophageal strictures., Materials and Methods: Fluoroscopically guided esophageal balloon dilation was performed on 589 patients with benign esophageal strictures during an 18-year period. The strictures had a range of causes: postoperative anastomotic stricture, corrosive stricture, postradiation stricture, esophageal achalasia, esophageal reflux, congenital stricture, esophageal web, esophageal ulcer, medication fibrosis, chronic inflammation, and posttraumatic stricture (in descending order of frequency). Esophageal rupture was assigned to one of three categories: type 1 was intramural, type 2 was transmural with a contained leak, and type 3 was transmural with an uncontained mediastinal leakage., Results: A total of 1421 procedures were performed in 589 patients, with each patient undergoing 1-29 procedures. The technical success rate was 99.8%, and the clinical success rate was 91.7%. Patients with corrosive stricture underwent the highest number of procedures (mean, 4.38 procedures). The incidence of esophageal rupture was 14.7%. All esophageal ruptures were detected immediately after the procedure. Most ruptures (98.6%) were types 1 and 2 and were successfully managed conservatively. Only 1.4% of the ruptures were type 3 and required active management. One of the type 3 ruptures was successfully treated with a retrievable covered stent. Two patients with type 3 ruptures (0.96% of ruptures) underwent surgery and were successfully treated. The rupture rate was not statistically related to the diameter of balloon used., Conclusion: The incidence of esophageal rupture after fluoroscopically guided esophageal balloon dilation was 14.7%. Almost all ruptures were type 1 or 2 and were successfully managed conservatively. Only 1.4% of the ruptures were type 3 and required active management. There was no procedure-related mortality in any patient. Therefore, in spite of the high incidence of ruptures, fluoroscopically guided balloon dilation is a safe procedure, particularly if a rupture is identified early and managed appropriately.

Purpose: To compare retrospectively percutaneous transhepatic primary placement of a retrievable self-expanding metallic stent with percutaneous balloon dilation for the treatment of benign biliary strictures., Materials and Methods: From 2005-2009, 66 patients with benign biliary strictures in whom an endoscopic approach failed or in whom such an approach was inaccessible were evaluated. Of 66 patients, 31 underwent balloon dilation, and 35 underwent temporary metallic stent placement. The etiologies of the benign strictures were anastomotic stricture after surgery (n = 54), stricture secondary to intraoperative injury (n = 9), inflammatory stricture (n = 2), and stricture secondary to trauma (n = 1)., Results: The primary patency rates were significantly better in the stent group (87% at 3 years) than in the balloon group (44% at 3 years; P = .022). The indwelling period of percutaneous transhepatic biliary drainage (PTBD) catheters after the initial procedure was able to be significantly reduced in the stent group (median 2.5 months) compared with the balloon group (median 4.5 months; P = .001). Significant bleeding (associated with PTBD) occurred in one patient in the balloon group. In the stent group, stent migration occurred in two patients, and one patient underwent surgery for stent removal after failure of removal under fluoroscopic guidance., Conclusions: Percutaneous primary placement of a retrievable self-expanding metallic stent showed superior intermediate-term results compared with percutaneous balloon dilation for the treatment of benign biliary strictures. In addition, the indwelling period of PTBD catheters can be significantly reduced using temporary stent placement., (Copyright © 2011 SIR. Published by Elsevier Inc. All rights reserved.)

Clinical outcomes of 11 patients who underwent cutting balloon treatment for the presence of benign airway strictures resistant to conventional balloon dilation are described. Cutting balloon treatment was technically and clinically successful in all 11 patients, with no major complications. During the mean 12.7-month follow-up period, there was recurrence in two patients, and the mean symptomatic improvement period was 23.1 months. The symptomatic improvement rates were 89% at 1 year and 59% at 2 years. Cutting balloon dilation can be a safe and effective therapeutic option for the treatment of benign bronchial strictures resistant to conventional balloon dilation.

Objective: The purpose of this article is to assess the safety and long-term efficacy of fluoroscopically guided balloon dilation for pharyngoesophageal strictures after radiation therapy in patients with head and neck cancers., Materials and Methods: From April 1997 to February 2009, fluoroscopically guided balloon dilation was performed in 17 patients with pharyngoesophageal strictures caused by radiation therapy. Technical success, clinical success (decrease of at least one grade in dysphagia score and good contrast passage on 1-month follow-up esophagogram), recurrence of dysphagia, and complications related to the procedure were retrospectively evaluated., Results: All 17 patients underwent 41 balloon dilation procedures, with each patient undergoing one to seven procedures (mean, 2.4 procedures). The technical success rate was 100%, and clinical success was achieved in 64.7% (11/17) of the patients. Five patients (29.4%) showed no recurrence of dysphagia after one session of balloon dilation. Of 12 patients (70.6%) with recurrence of dysphagia, 10 underwent repeat balloon dilation and two underwent gastrostomy after the first session of balloon dilation. The maximum balloon diameters were 15 mm (n = 22), 20 mm (n = 16), and 25 mm (n = 3). As minor complications, three cases of type 1 esophageal rupture occurred in two patients (11.8%). There were no major complications., Conclusion: Although the recurrence rate was high with repeat balloon dilation, fluoroscopically guided balloon dilation seems to be a simple and safe primary treatment technique for pharyngoesophageal stricture due to radiation therapy in patients with head and neck cancer.

A benign anastomotic stricture is a common complication of upper gastrointestinal (UGI) surgery and is difficult to manage conservatively. Fluoroscopically guided balloon dilation has a number of advantages and is a safe and effective procedure for the treatment of various benign anastomotic strictures in the UGI tract.

Purpose: To prospectively evaluate an algorithm for palliative treatment of unresectable esophagogastric junction tumors based on stricture length., Materials and Methods: Eighty-six patients with malignant esophagogastric obstructions were referred to the interventional radiology department for balloon dilation or stent placement due to dysphagia. Balloon dilation was performed in patients (n = 39) with a short segmental (< or =4 cm) stricture, whereas stent placement was performed in patients (n = 47) with a long segmental (>4 cm) stricture. In the balloon group, 16 patients with esophageal carcinoma underwent both chemotherapy and radiation therapy, whereas 23 patients with gastric carcinoma underwent only chemotherapy., Results: Technical success was achieved in all procedures in all patients (100%). The overall clinical success rate of balloon dilation and stent placement for a malignant esophagogastric junction was 87% (75 of 86 patients). Clinical success was achieved in 29 of the 39 patients in the balloon group (74%) and 98% (46 of the 47 patients in the stent group (98%). The overall complication rate was 21% (18 of 86 patients). Seventeen complications, which consisted of reflux (n = 8), migration (n = 6), tumor overgrowth (n = 2), and tissue hyperplasia (n = 1), occurred after stent placement, whereas one complication (intramural rupture) occurred after balloon dilation. The median symptom-free and survival periods were 120 (95% confidence interval: 114, 263) and 147 (95% confidence interval: 98, 196) days, respectively., Conclusions: The treatment strategies seem to be reasonable for palliative therapy in patients with malignant esophagogastric junction obstructions. However, further investigations are needed to minimize the drawbacks of the methods and to determine optimal treatments in patients with unresectable malignant esophagogastric junction obstructions.

Purpose: To retrospectively evaluate the long-term results of balloon dilation in the treatment of corrosive esophageal strictures and to identify prognostic factors associated with clinical outcome., Materials and Methods: From January 1987 to June 2006, balloon dilation was undertaken in 117 patients with corrosive esophageal strictures. Information on recurrence and complications was obtained. Recurrence rates and factors predicting recurrences were evaluated with Kaplan-Meier survival analysis and Cox multivariate analysis. Tested variables were age, sex, corrosive agent, stricture length, stricture number, severity of stricture as judged by the resistance to dilation, and stage (early chronic [3 weeks to 6 months] vs late chronic [>6 months])., Results: The mean follow-up period was 51 months (range, 1-174 months). Thirty patients (26%) had no recurrence after initial balloon dilation. Twenty-three patients (20%) experienced no recurrence after one or two additional balloon dilation procedures. Forty-five of 117 patients (38%) experienced esophageal rupture (mostly intramural rupture). Early chronic stage (P=.003) and resistance to balloon dilation in the late chronic stage (P=.034) were significantly associated with recurrence after balloon dilation., Conclusions: Balloon dilation is associated with minimal complications and is valuable as an initial therapy in patients with corrosive esophageal stricture. However, the recurrence rate after balloon dilation is rather high, with early chronic stage and resistance to dilation in the late chronic stage associated with poor clinical outcome. An algorithm combining balloon dilation with temporary stent placement is proposed for the subsets of patients prone to stricture recurrence.

Purpose: To evaluate the clinical efficacy and safety of balloon dilation and stent placement in the treatment of early benign anastomotic strictures after gastric surgery., Materials and 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.

Purpose: To present the preliminary results of beta irradiation with use of liquid rhenium 188 ((188)Re)-filled balloon dilation in the treatment of refractory benign airway strictures., Materials and Methods: Ten sessions of beta irradiation by using liquid (188)Re-filled balloon dilation were prospectively performed in nine patients with refractory bronchial strictures between 2003 and 2006. Indications for treatment were dyspnea caused by repeat stricture or no response to previous treatment (ie, balloon dilation and/or temporary stent placement or laser therapy) in seven patients and dyspnea caused by exuberant granulation tissue formation at the distal end of the placed stent in two. To assess the treatment efficacy, the authors calculated and compared the mean intervals of interventional treatments before and after dilation with (188)Re and mercaptoacetyltriglycine (MAG(3))-filled balloons., Results: Liquid (188)Re-filled balloon dilation was successfully performed in all nine patients, with no procedure-related complications. Immediately after the procedure, all patients showed resolution of their dyspnea. Five patients remained asymptomatic at 5-25-month follow-up. Four patients experienced dyspnea caused by recurrent stricture 1-10 months after dilation. The mean intervals between interventional treatments increased significantly from 3.1 months +/- 2.1 before (188)Re-MAG(3)-filled balloon dilation to 10.8 months +/- 8.8 after (188)Re-MAG(3)-filled balloon dilation in all nine patients (Wilcoxon signed rank test, P = .025)., Conclusions: beta irradiation with liquid (188)Re-filled balloon dilation can be safely used for refractory benign airway strictures. A large study with longer follow-up is needed to draw a definite conclusion.

Purpose: To compare the long-term clinical effectiveness of fluoroscopically guided double and endoscopically guided single balloon dilations in esophageal achalasia., Materials and Methods: Thirty-two fluoroscopically guided balloon dilations were performed in 21 patients (group A) and 48 endoscopically guided balloon dilations were performed in 37 patients (group B). The double balloon dilation technique (10 + 20-mm, 15 + 20-mm or 20 + 20-mm in diameter), with preceding single balloon dilation (10, 15, or 20-mm in diameter), was used in group A, whereas the single balloon dilation technique (30, 35, or 40-mm in diameter) with gradually increased internal pressure was used in group B. Technical success, clinical success, complications, and primary/secondary patency rates were compared between the two groups., Results: All procedures were technically successful without esophageal perforation. Clinical success was achieved in 97% (31/32) and 92% (44/48) of balloon dilations in groups A and B, respectively. The symptomatic improvement in dysphagia was significantly higher in group A than in group B. Incidence of complications was the same (18.8%) in both groups. Group A showed significantly longer primary and secondary patency periods than did group B (P < 0.05)., Conclusion: Fluoroscopically guided double balloon dilation has greater long-term effectiveness than endoscopically guided single balloon dilation in the treatment of esophageal achalasia.

Objective: Benign airway strictures refractory to balloon dilatation or stent placement remain a challenge in interventional radiology. This article describes the successful use of a cutting balloon to treat three cases of recurrent tuberculous bronchial strictures., Conclusion: In three patients, cutting balloon dilatation was found to be safe and effective and did not cause complications. Although the dilated lumen showed partial reduction over the 6- to 12-month follow-up, subjective functional symptoms and dyspnea grade improved.

Purpose: To evaluate the safety and efficacy of mitomycin-C irrigation after balloon dacryocystoplasty in the treatment of epiphora caused by obstruction of the lacrimal system., Materials and Methods: Thirty-five lacrimal systems in 33 patients with obstruction of the lacrimal system were assigned to one of two groups: 17 lacrimal systems were irrigated with mitomycin-C after balloon dacryocystoplasty (mytomycin-C group), and 18 were not irrigated with mitomycin-C after balloon dacryocystoplasty (non-mitomycin-C group). In the mitomycin-C group, the lacrimal systems were irrigated with 0.2 mg/mL mitomycin-C via the inferior lacrimal punctum in three different sessions: immediately, 1 week, and 1 month after balloon dacryocystoplasty. The cumulative patency rates after balloon dacryocystoplasty were calculated by using the Kaplan-Meier method and were compared between the two groups with use of the log-rank test., Results: Balloon dacryocystoplasty and subsequent mitomycin-C irrigation were technically successful in all lacrimal systems. There were no side effects or complications associated with mitomycin-C use. The cumulative patency rate in the mitomycin-C group was significantly higher than that in the non-mitomycin-C group after balloon dacryocystoplasty (P = .0150, log-rank test)., Conclusions: Mitomycin-C irrigation is safe and effective in increasing the patency rate of the lacrimal system after balloon dacryocystoplasty.

Background: Although balloon dilation is a safe procedure, it can lead to laceration of the airway, causing bleeding, pneumothorax, pneumomediastinum, or mediastinitis. We therefore determined the incidence and clinical significance of tracheobronchial lacerations after balloon dilation for treatment of benign tracheobronchial strictures., Methods: We evaluated 97 patients who had undergone balloon dilation in 124 sessions for the treatment of benign tracheobronchial strictures. The degree of airway laceration was evaluated bronchoscopically. The cumulative airway patency rate after balloon dilation was compared in patients with and without lacerations using Kaplan-Meier survival curves and log-rank testing., Results: There were 64 tracheobronchial lacerations (51.6%) during the 124 sessions of balloon dilation. Of these, 60 were superficial and 4 were deep, but there were no incidents of transmural laceration. In patients with lacerations, mild chest pain (n = 5), blood-tinged sputum (n = 21), and pneumomediastinum (n = 2) occurred, but all resolved completely within 24 h. All superficial lacerations healed spontaneously within 1 month, and all deep lacerations healed 2 to 9 months after conservative treatment. During the follow-up period, the median cumulative airway patency period in patients with and without lacerations was 24 and 4 months (p < 0.05), respectively., Conclusion: Laceration secondary to balloon dilation in the tracheobronchial tree is relatively common but rarely progresses to transmural laceration and may improve patency outcomes.

Objective: A technique is presented for catheterization of an obstructed bronchus when use of a conventional vascular catheter has failed. In some cases, strictures become too stenotic or blunt for passage of a guidewire, making further intervention impossible. We attempted to negotiate a stricture opening using a transjugular intrahepatic portosystemic shunt (TIPS) dilator with a guidewire inside it., Conclusion: The catheterization technique with a TIPS dilator was successful in nine cases in which use of conventional catheters and guidewires had failed.

Purpose: To evaluate the clinical efficacy and safety of fluoroscopically guided balloon dilation of gastric outlet obstruction caused by benign anastomotic stricture., Materials and Methods: Fluoroscopically guided balloon dilation was performed on 17 patients with gastric outlet obstruction caused by benign anastomotic stricture. Fourteen patients underwent surgery for malignant disease and three patients for complication of benign gastric ulcer. The sites of anastomotic stricture were gastrojejunal (n = 12) or gastroduodenal (n = 5). An upper gastrointestinal (UGI) series was performed just following and 1 month after balloon dilation to evaluate both the clinical success of the procedure and any complications. A dietary intake was evaluated by using the score for patients with malignant dysphagia and the pre- and postballoon dilation scores were analyzed with the Wilcoxon signed rank test., Results: In all patients, fluoroscopically guided balloon dilation was performed in one (n = 15) or two (n = 2) sessions and was technically and clinically successful (100%). The diameters of the balloon catheters used were 15 mm (n = 4), 20 mm (n = 14), and 25 mm (n = 1 mm; mean, 19.5 mm) in a total of 19 sessions. All patients had significant improvement of their levels of dietary intake (P < .001). Two of the 17 patients required the second procedure due to recurrent symptom nine and 15 months, respectively, after initial balloon dilation. Overall, 16 patients (94%) showed good results and no recurrence during a mean follow-up period of 13.5 months (range, 5-39 months). There were no major complications associated with balloon dilation., Conclusion: Fluoroscopically guided balloon dilation seems to be effective and safe for patients with gastric outlet obstruction caused by benign anastomotic stricture. Achieving a luminal diameter of 20 mm seems to be necessary to prevent recurrence of symptoms.

Fluoroscopically guided balloon (15 or 20 mm in diameter) dilation was performed on eight patients with benign duodenal strictures caused by peptic ulcers (n = 6), Crohn's disease (n = 1), and postoperative adhesion (n = 1). The procedure was technically and clinically successful without complications in seven of the eight patients (88%). Duodenal perforation occurred immediately after 20-mm-diameter balloon dilation in one patient who underwent emergency surgery. During the mean follow-up of 30 months (range, 2-103 months), there was recurrence in two of the seven patients (29%) who then underwent surgery. The other five patients (71%) showed good results with no recurrence.

Purpose: To evaluate the therapeutic efficacy and complications of fluoroscopically guided double balloon dilation for treatment of colorectal anastomotic strictures., Materials and Methods: Under fluoroscopic guidance, 17 patients with colorectal anastomotic strictures underwent transanal double balloon dilation. Thirteen of 17 strictures were the consequence of surgery for malignant disease and the other four were secondary to surgery for benign disease. Sixteen of 17 patients had difficult or frequent defecation caused by partial obstruction. In the remaining one asymptomatic patient, the stricture was detected by endoscopy and barium enema after total proctocolectomy and a temporary ileostomy for ulcerative colitis. The therapeutic efficacy and complications were evaluated during the follow-up., Results: Seventeen patients underwent double balloon dilation in a single session. The diameter of the first balloon was 20 mm and the second balloon's diameter was 10, 15, or 20 mm. Technical success was achieved in all 17 patients. After balloon dilation, complete (n = 12, 71%) or incomplete (n = 5, 29%) improvement of symptoms was achieved in all patients. Major complications such as perforation or severe hemorrhage did not occur. During the mean follow-up period of 23 months (range, 1-62 months), one patient (6%) developed a recurrent stricture and required a second session of double balloon dilation 6 months after initial balloon dilation., Conclusion: Fluoroscopically guided double balloon dilation is an effective and safe method for the treatment of colorectal anastomotic strictures.

Simple Summary: Balloon-occluded transcatheter arterial chemoembolization (B-TACE), in which a microballoon catheter is used to temporarily occlude the tumor feeding artery, was introduced to increase complete response (CR) rates. However, assessing the quality of CR in terms of the therapeutic outcomes of B-TACE is necessary because the evaluation of local recurrence (LR) may provide more detailed information on the ability of the B-TACE to result in a local cure. This study aimed to determine the LR rate and identify factors associated with LR in patients who achieve a radiological CR after undergoing subsegmental B-TACE for HCC. The CR rate after B-TACE was 97.2% at first follow-up. Oily subsegmentectomy, defined as radiological CR of the HCC and peritumoral parenchymal necrosis, can be considered as an index of successful treatment because it did not demonstrate any LR. The aim of this study was to determine the local recurrence (LR) rate and identify factors associated with LR in patients who achieve a radiological complete response (CR) after undergoing balloon-occluded transcatheter arterial chemoembolization (B-TACE) for hepatocellular carcinoma (HCC). From November 2017 to September 2021, 60 patients (44 men, 16 women; mean age, 63.5 years; range, 39–82 years) with 72 HCCs (mean diameter, 31 mm; range, 10–50 mm) who underwent subsegmental B-TACE were included in this retrospective study. Radiological and clinical evaluation of oily subsegmentectomy, defined as radiological CR of the HCC and peritumoral parenchymal necrosis, was performed. The CR rate was 97.2% (70 of 72 HCCs) at first follow-up (mean, 41 days; range, 14–110 days). Overall, 13 HCCs (19.7%) demonstrated LR at a mean of 29.8 months (range, 3–63 months) and cumulative LR rates were 1.5% 14.2% 21%, 21%, and 21% at 6, 12, 24, 36, and 48 months, respectively. In 28 (38.9%) of 72 HCCs, oily subsegmentectomy was achieved, tumor markers were normalized, and LR did not occur. The oily subsegmentectomy-positive group had a significantly lower LR rate than the oily subsegmentectomy-negative group (p = 0.001). Age ≥65 years (adjusted hazard ration (HR), 0.124; 95% confidence interval (CI), 0.037–0.412; p < 0.001) and peripheral location (adjusted HR, 0.112; 95% CI, 0.046–0.272; p < 0.001) were independent predictive factors of LR. Subsegmental B-TACE can be an effective method with a high initial CR rate and low LR incidence. Oily subsegmentectomy can be considered as an index of successful treatment because it did not demonstrate any LR. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the safety and efficacy of balloon-occluded transcatheter arterial chemoembolization (B-TACE) for the treatment of HCC refractory to conventional TACE (C-TACE).Methods: This single-center retrospective analysis included 60 consecutive patients who underwent B-TACE (mean age, 61.4 years; male:female ratio, 4.5:1) for the treatment of residual viable (n = 40) or recurrent HCC (n = 20) refractory to C-TACE between November 2017 and November 2018. Technical success, radiologic response rate (proportion of the patients achieving complete response [CR] or partial response [PR] on first follow-up CT according to m-RECIST), major complication rate, and time to progression (TTP) were evaluated. The TTP of B-TACE was also compared with that of the last C-TACE. Factors associated with achieving CR and TTP were explored.Results: B-TACE resulted in 100% technical success and radiologic response rate (CR in 45 and PR in 15 patients). The major complication rate was 6.7% (4/60). The median TTP after B-TACE was 5.3 months (95% confidence interval [CI], 4.0-6.9 months). The TTP of B-TACE for treating residual HCC was significantly longer than that of the last C-TACE (median [95% CI], 4.4 [3.2-6.9] vs. 2.7 [2.3-4.4] months; p = 0.013). BCLC stage C (adjusted OR, 4.448; 95% CI, 1.691-11.700; p = 0.002) and multiplicity of HCC (adjusted OR, 2.746; 95% CI, 1.206-6.251; p = 0.016) were significantly associated with tumor progression after B-TACE.Conclusions: B-TACE is safe and effective for the treatment of HCC refractory to C-TACE. BCLC stage C and multiplicity of HCC were independent factors associated with TTP after B-TACE.Key Points: • B-TACE for the treatment of HCC refractory to C-TACE showed a 100% radiologic response at first follow-up and a significantly longer TTP than the last C-TACE when treating residual tumor. • The major complication rate after B-TACE was 6.7%. Although AST, ALT, and total bilirubin increase were more profound in B-TACE than in the last C-TACE, these were normalized at the first follow-up. • Tumor size, multiplicity of HCC, and hepatic arterial injury were independent factors associated with achieving a complete response. BCLC stage C and multiplicity of HCC were significantly associated with TTP after B-TACE. [ABSTRACT FROM AUTHOR]