Thirty years in the magic of balloon catheters: the role of balloon catheter dilatation in peptic oesophageal stenosis

Introduction: In May of 1979, we were the first in the world to use balloon catheter dilatation of the oesophagus. In this paper, we would like to summarize our 30 years of experience on the balloon catheter dilatation of peptic stenosis.

Patient and methods: Between May of 1979 and July of 2008, there were 399 patients 1338 times were dilatated due to peptic oesophageal stenosis.

Results: The ratio of males to females on dilatation due to peptic stenosis was 2.9:1. Males had more dilatations than females (p=0.004). As the result of the dilatation more than 95% of the patients complaints such as vomiting and pain ceased and the average dysphagia score decreased from 2.4 to 0.3. Body weight of dysphagic patients decreased before treatment (p<0.001), then increased (p<0,001). The average diameter of narrowing due to the treatment increased from 5±2.4mm to 14.1±2.4mm (p<0.001), average length decreased from 4.1±2.7cm to 2.7±1.6cm (p<0.001). If the diameter of narrowing was <7mm more interventions were needed than >7mm (p<0.001). There were more dilatation needed if the stenosis was >2,5cm in length than if it was shorter (<2,5cm). If the pressure applied at the first dilatation was higher, than more dilatations were necessary (p<0,001). Among our patients 261 (77%) had hiatal hernia with peptic stenosis. Their average size was 4.1±1.8cm. Large hiatal hernias (>2,5cm) with peptic stenosis had significantly more dilatation compare to small hernias (<2.5cm). 81 (23.9%) of patients was alcoholic; male to female ratio was 9:1. Among this group of patients the average age at dilatation was 6 years less (p<0.001), their stenosis narrower (p<0.001) compare to patients without alcohol abuse. During dilatations, we encountered one transmural perforation (0.074%).

Conclusion: The use of balloon catheter dilatation is safe and very effective method in the treatment of peptic oesophageal stenosis. In peptic stenosis not only the diameter and the length but also the compliance of the narrowing are important prognostic factors.