Balloon dilatation

Henkes H, Miloslavski E, Lowens S, Reinartz J, Liebig T, Kuhne D. Treatment of intracranial atherosclerotic stenoses with balloon dilatation and self-expanding stent deployment (WingSpan). Neuroradiology 2005 47 222-228. 

Gastric outlet obstruction occurs in approximately 2% of patients with PUD and is usually caused by ulcer-related inflammation or scar formation near the peripyloric region. Signs and symptoms of outlet obstruction include early satiety after meals, nausea, vomiting, abdominal pain, and weight loss. Ulcer healing with conventional acid-suppressive therapy is the primary treatment, but if this is unsuccessful then an endoscopic procedure (e.g., balloon dilation) is required. 

A full-term girl with pulmonary atresia and an intact intraventricular septum had balloon dilatation of the pulmonary valve performed on the third day of life. 

G9. Guelrud, M., and Siegel, J. H., Hypertensive pancreatic duct sphincter as a cause of pancreatitis. Successful treatment with hydrostatic balloon dilatation. Dig. Dis. Sci. 29, 225-231 (1984). 

Sierevogel MJ, Pasterkamp G, Velema E, et al. Oral matrix metalloproteinase inhibition and arterial remodeling after balloon dilation—an intravascular ultrasound study in the pig. Circulation 2001 103 302-307. 

The first report of percutaneous balloon dilation of a pulmonary valve was published in 1982 (14). Today the transcatheter approach has largely replaced surgical valvulotomy for pure stenosis. Surgery is only necessary when balloon dilatation was not successful or other heart abnormalities demand an open heart procedure. 

Since the first steps in transluminal balloon dilation of mitral valves in 1982 (24) numerous techniques have been described. One method is to access the left atrium with a transseptal puncture from the venous side (antegrade). Another way is to advance the catheter via the aorta into the left ventricle and perform the valvulotomy from the arterial side (retrograde). The use of two dilation balloons introduced via the transseptal approach is a common technique described by Bonhoeffer using a monorail-type system over a single guidewire (25). 

Achalasia, in which there is failure of relaxation of the lower oesophageal sphincter, may be relieved by balloon dilatation or by injection of botulinum toxin at the gastro-oesophageal jrmction. 

Crohn s disease may be complicated by intestinal strictures, fistulae and intra-abdominal abscesses. Surgery is often necessary but strictures may be amenable to endoscopic balloon dilatation and abscesses can be drained under radiographic control. 

Kaya, M., Petersen, B.T., Angulo, R, Baron, T.H., Andrews, J.C., Gos-tout, C.J., Lindor, K.D. Balloon dilation compared to stenting of dominant strictures in primary sclerosing cholangitis. Amer. J. Gastroenterol. 2001 96 1059-1066... 

Rossi, R, Saivatori, F.M., Bezzi, M., Maccioni, R, Rorcaro, M.L., Ricci, R Percutaneous management of benign biliary strictures with balloon dilatation and selfexpanding metallic stents. Cardiovasc. Intervent. Radiol. 1990 13 231-239... 

Fig. 39.6 Budd-Chiari syndrome pronounced collateral circulation resulting from thrombotic occlusion of the right hepatic vein. Re-opening of the vessel and rapid reduction of the collateral vessels following successful balloon dilatation...

Scopolamine (hyoscine N-butylbromide) is available as an antispasmodic product (20 mg ampule for injection and 20 mg tablets) for use in humans. In addition, there is a veterinary product that contains scopolamine and dipyrone approved for use as an antispasmodic/analgesic in animals. In addition to blocking the effects of acetylcholine at the muscarinic receptor, scopolamine affects nicotinic receptors in intestinal ganglia and does not affect the CNS. In horses, scopolamine is used as an antispasmodic and to relax the rectum to facilitate abdominal palpation. In one report, 0.2 mg/kg was as effective as 0.2 mg/kg scopolamine plus 2.5 mg/kg dipyrone in relieving discomfort caused by balloon dilatation of the cecum (Roelvink et al 1991). The analgesic effect tasted for 20 min. 

Pharmaceutical treatments for this common but annoying condition include finasteride (trade name Proscar) and terazosin (trade name Hytrin). Surgical procedures include the TURP procedure (transurethral resection of the prostate) and balloon dilation. 

Wilkens GT, Weyman AE, Abascal VM, et al. Percutaneous balloon dilatation of the mitral valve an analysis of echocar-diographic variables related to outcome and the mechanism of dilatation. Br Heart J 1988 60 299-308. 

Percutaneous transluminal angioplasty or balloon dilation of the coronary artery results in a dramatic clinical response in many patients. Long-term benefit, however, is dependent on the progression of the disease at the dilated site °. The factors which determine the rate of progression of the disease or the development of acute coronary occlusion are not known but pathological evidence of severe trauma with deposition of platelets and endothelial loss at the angioplasty site suggest that eicosanoids may be important . ... 

Balloon dilatation is the preferred treatment above traditional bougienage, and surgery is rarely indicated. 

Fig. 2.29a-c. Balloon dilation of an esophageal stricture, a Severe stenosis of the proximal esophagus 3 months after repair, b Dilatation balloon expanded across the narrowing, no extravasation, c Post-dilatation appearance... 

Allmendinger N, Hallsey M), Markowitz SK et al (1996) Balloon dilatation of esophageal strictures in children. I Pediatr Surg 31 334-336... 

Fasulakis S, Andronikou S (2003) Balloon dilatation in children for esophageal strictures other than those due to primary repair of oesophageal atresia, interposition or restrictive fundoplication. Pediatr Radiol 33 682-687 Fernbach SK, Glass RBJ (1988) The expanded spectrum of limb anomalies in the VATER association. Pediatr Radiol 18 215-220... 

The success rate of balloon dilatation is reported to range from 62.5% to 79%. In cases of post-surgical stenosis and gastroesophageal reflux-induced ste-... 

Although a safe procedure, contraindications for balloon dilation do exist, and these are considered to be multiple (> 3) strictures, long strictures (> 5 cm), tortuous strictures, or patients with tracheoesophageal fistulas (Hamza et al. 2003). 

PTC is not only used for catheter drainage but it also allows for dilatation of strictures of the biliary tree, which in children is mostly in cases of biliary-enteric anastomoses (Sze and Esquivel 2002). The advantage of balloon dilatation of strictures is the relatively minimal invasive approach and that, if dilatation fails, surgical options remain viable. Lorenz et al. (2005) reported their experience in 19 children over a 7-year period. In their study, 58% of patients showed a patent biliary-enteric anastomosis after 1 year (continued patency ranged from 1.4 to 5.4 years, mean patency 3.6 years). 

Kaye RD, Sane SS, Towbin RB (2000b) Pediatric intervention an update-part I. J Vase Interv Radiol 11 683-697 Kim 10, Yeon KM, Kim WS, Park KW, Kim JH, Han MC (1993) Perforation complicating balloon dilation of esophageal strictures in infants and children. Radiology 189 741-744... 

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