Clinical outcomes of large diameter balloon angioplasty for Budd-Chiari syndrome with inferior vena cava involvement

Small Balloon Dilation Versus Bougie Dilation Versus Large Balloon Dilation for the Treatment of Benign Esophageal Strictures in Adult Patients

RATIONALE AND OBJECTIVES

The optimal treatment for benign esophageal strictures (BES) is still unknown, small balloon dilation (6-24mm in diameter) and bougie dilator dilation (5-17mm in diameter) are usually used clinically, while large balloon dilation (25-30mm in diameter) is rarely used due to the potential risk of esophageal rupture and massive bleeding. According to the different choices of treatment, we grouped the patients into three groups and compared their safety and effectiveness to explore the optimal treatment of BES.

MATERIALS AND METHODS

Between July 2016 and March 2024, 104 consecutive patients with BES who underwent dilation of small balloon (Group S, n=30), bougie dilator (Group B, n=38) or large balloon (Group L, n=36) were retrospectively evaluated. Data were collected to analyze the technical success, safety and clinical outcome of the dilations as evaluated by dysphagia score, complications and recurrence.

RESULTS

Technically success rates of Group S, Group B and Group L were 97.0%, 96.7% and 89.9%, respectively (P=0.0507). Recurrence of stricture and esophageal rupture were the reasons for technical failures in balloon and bougie dilation. Esophageal ruptures occurred in 11 dilations as follows: 4 (3.0%) in the Group S, 2 (1.7%) in the Group B and 5 (7.2%) in the Group L (P=0.1184). Among them, two patients with type III rupture had temporary removable esophageal stent placed, and rupture healed after stents removal. Two patients with type II rupture had the rupture clamped with titanium clips. A total of 55/104 patients (52.9%) were cured with no dysphagia after the end of follow-up as follows: 12 (40.0%) in the Group S, 18 (47.4%) in the Group B and 25 (69.4%) in the Group L (P=0.0385). Less No. of dilation sessions and shorter duration of treatment were required in the Group L than in the Group S or the Group B (P<0.05). Total hospitalization cost was higher in the Group S than in the Group B or the Group L (P<0.05).

CONCLUSION

Both balloon dilation and bougie dilation are safe and effective for patients with benign esophageal strictures. Large balloon dilation seems to be preferable to small balloon dilation and bougie dilation regardless of the condition of adult BES, as they are associated with higher clinical effectiveness, less required dilation, and reduced duration of treatment.

A comparison of three kinds of balloon dilatations for patients with benign esophageal strictures

Benign esophageal strictures (BES) have been usually treated with balloon dilatation with occasionally drug-coated balloon (DCB) or large balloon dilatation. We compared the clinical outcomes of 3 types of dilatations: small balloon dilatation, DCB dilatation, and large balloon dilatation for the treatment of BES. This retrospective study evaluated 3 groups of 82 consecutive patients with BES who underwent dilatation of either small balloon (Group S, n = 25), DCB (Group D, n = 22) or large balloon (Group L, n = 35). Technical success, dysphagia score, safety and recurrence of stricture were collected and evaluated. Technical success rates of dilatation procedure were 88.7%, 87.1% and 89.7% in Group S, Group D and Group L, respectively (P = 0.9291). Rupture occurred in 8 dilatations: two (2.8%) in the Group S, one (3.2%) in the Group D and 5 (7.4%) in the Group L (P = 0.4109). The final scores in Group L (0.4 ± 0.9) was significantly lower than that in Group S (1.3 ± 1.5) or Group D (1.3 ± 1.4; P < 0.01). A total of 44/82 patients (53.7%) were cured with no dysphagia after the end of follow-up: 10 (40.0%) in the Group S, 9 (40.9%) in the Group D and 25 (71.4%) in the Group L. Group L showed the best clinical effectiveness among the three groups (P = 0.0272). Longer hospitalization was required in the Group D (median 21.0, interquartile range [IQR] 10.0-49.5) than in the Group S (median 14.0, IQR 9.0-24.0) or the Group L (median 12.0, IQR 8.0-24.0, P = 0.0112). More hospitalization cost was required in the Group D (median 6.9 months, IQR 3.7-11.2 months) than in the Group S (median 4.0 months, IQR 2.6-6.8 months) or the Group L (median 3.1, IQR 2.1-6.3, P = 0.0006). In conclusion, large balloon dilatation is a safe and effective treatment for BES, with higher clinical effectiveness, shorter hospitalization and lower hospitalization cost. The use of DCB seems least preferable, as they are associated with more hospitalization cost and few cases of clinical improvement.

Long-term outcomes of large balloon dilatation for benign anastomotic stricture following surgical resection of esophageal cancer

Surgical resection of esophageal cancer may result in benign anastomotic strictures, which are usually treated by balloon dilatation. Here we reported the long-term outcomes of large balloon dilatation for benign anastomotic strictures secondary to esophagectomy for esophageal cancer. From February 2011 to December 2016, 27 esophageal cancer patients underwent large balloon dilatation for benign strictures following surgical resection. Clinical success rate, number of dilatation sessions, complication rate, and mortality rate were evaluated. A total of 27 patients developed a benign stricture at the esophagectomy site. A total of 50 dilatation sessions of large balloon were performed, with a mean of 1.8 sessions per patients (range 1.0-5.0). Only 1 perforation was observed (2.0% per dilatation session), and required no surgery. No procedure-related deaths were recorded. Large balloon dilation was technically successful in the remained 26 patients (96.3%). Dysphagia score and stricture index decreased significantly (P < .0001). Proximal diameter of stricture, stricture diameter and length decreased significantly. Patients were followed up for 36.3 ± 7.1 months, and 14 patients survived without dysphagia. The survival rates were 95.0%, 69.1%, 34.5% for 1, 5, and 9 years, respectively. The median survival was 96.0 months. Large balloon dilatation can be a safe and feasible treatment for benign anastomic strictures following surgical resection of esophageal cancer, with a low perforation rate. However, further study compared with small balloon dilatation is warranted.

Establishing a jugular-femoral venous route for recanalization of complicated inferior vena cava in Budd-Chiari Syndrome after transfemoral access failure

Recanalization of inferior vena cava (IVC) with complete obstruction, old thrombosis or long segmental stenosis/obstruction (complicated IVC) via transfemoral access may fail in patients with Budd-Chiari syndrome (BCS). In this study, 34 consecutive patients with BCS underwent recanalization of complicated IVC occlusion via jugular-femoral venous (JFV) route establishment. BCS with complicated IVC was detected by reviewing preoperative color Doppler ultrasonography or computed tomography (CT) venography, and confirmed by intraoperative venography. Clinical data on technical success, complications, and follow-up outcomes were analyzed. Except for one patient received surgical repair of rupture IVC after recanalization, technical success of IVC recanalization was achieved in remaining 33 (97.1%) patients. No perioperative deaths was found. Three complications were observed during recanalization, for a complication rate of 8.8%. Bleeding of the femoral vein was observed in one patient, and two patients showed bleeding of IVC. The IVC lesion diameter and blood flow of the distal IVC increased significantly after the procedure. Twenty-four patients (77.4%) were clinically cured, and four patients (12.9%) showed clinical improvement. The 1-year, 3-year, 5-year primary patency rates were 85.9%, 76.4% and 70.0%, respectively. The 5-year secondary patency rate was 96.8%. There were three deaths during follow up, and the 5-year survival rate was 90.0%. In conclusion, JFV route establishment and angioplasty for complicated IVC is safe and effective for patients with BCS after transfemoral access failure.