Balloon dilation of congenital perforated duodenal web in newborns: Evaluation of short and long-term results

BACKGROUND Incomplete congenital duodenal obstruction(ICDO)is caused by a congenitally perforated duodenal web(CPDW).Currently,only six cases of balloon dilatation of the PDW in newborns have been described.AIM To present our experience of balloon dilatation of a perforated duodenal memb-rane in newborns with ICDO.METHODS Five newborns who underwent balloon dilatation of the CPDW along a prein-stalled guidewire between 2021 and 2023 were included.Nineteen newborns diagnosed with ICDO who underwent laparotomy were included in the control group.RESULTS In all cases,good anatomical and clinical results were obtained.In three cases,a follow-up study was conducted after 1 year.The average time to start enteral feeding per os was significantly earlier in the study group(4.4 d)than in the laparotomic group(21.2 days;P<0.0001).The time spent by patients in the intensive care unit and hospital after balloon dilatation was also significantly shorter.We determined the selection criteria for possible and effective CPDW balloon dilatation in newborns as follows:(1)Presence of dynamic radiographic signs of the passage of a radiopaque substance beyond the zone of narrowing or radiographic signs of pneumatisation of the duodenum and small bowel distal to the web;(2)presence of endoscopic signs of CPDW;(3)successful cannulation with a guidewire performed parallel to the endoscope,with holes in the congenital duodenal web;and(4)successful positioning of the balloon performed along a freestanding guidewire on the web.CONCLUSION Strictly following selection criteria for newborns with ICDO caused by CPDW ensures that endoscopic balloon dilatation using a pre-installed guidewire is safe and effective and shows good 1-year follow-up results.

Limited endoscopic sphincterotomy plus large balloon dilation for choledocholithiasis with periampullary diverticula

AIM: To investigate the effectiveness and safety of limited endoscopic sphincterotomy (EST) plus large balloon dilation (LBD) for removing choledocholithiasis in patients with periampullary diverticula (PAD). METHODS: A total of 139 patients with common bile duct (CBD) stones were treated with LBD (10-20 mm balloon diameter) after limited EST. Of this total, 73 patients had PAD and 66 patients did not have PAD (controls). The results of stone removal and complications were retrospectively evaluated. RESULTS: There were no significant differences between the PAD and the control groups in overall successful stone removal (94.5% vs 93.9%), stone removal in first session (69.9% vs 81.8%), mechanical lithotripsy (12.3% vs 13.6%), and complications (11.0% vs 7.6%). Clinical outcomes were also similar between the types of PAD, but the rate of stone removal in first session and the number of sessions were significantly lower and more frequent, respectively, in type B PAD (papilla located near the diverticulum) than controls [23/38 (60.5%) vs 54/66 (81.8%), P = 0.021; and 1 (1-2) vs 1 (1-3), P = 0.037, respectively] and the frequency of pancreatitis was significantly higher in type A PAD (papilla located inside or in the margin of the diverticulum) than in controls (16.1% vs 3.0%, P = 0.047). CONCLUSION: Limited EST plus LBD was an effective and safe procedure for removing choledocholithiasis in patients with PAD. However, some types of PAD should be managed with caution.

Minor endoscopic sphincterotomy followed by large balloon dilation for large choledocholith treatment

AIM To evaluate early and late outcomes of endoscopic papillary large balloon dilation(EPLBD) with minor endoscopic sphincterotomy(m EST) for stone removal.METHODS A total of 149 consecutive patients with difficult common bile duct(CBD) stones(diameter ≥ 10 mm or ≥ 3 stones) underwent conventional endoscopic sphincterotomy(EST) or m EST plus EPLBD from May 2012 to April 2016. Their demographic, laboratory and procedural data were collected, and pancreaticobiliary complications were recorded.RESULTS Sixty-nine(94.5%) of the patients in the EPLBD + m EST group and 64(84.2%) in the conventional EST group achieved stone clearance following the first session(P = 0.0421). The procedure time for EPLBD + m EST was shorter than for EST alone(42.1 ± 13.6 min vs 47.3 ± 11.8 min, P = 0.0128). The overall rate of early complications in the EPLBD + m EST group(11%) was lower than in the EST group(21.1%); however, the difference was not significant(P = 0.0938). The cumulative recurrence rate of cholangitis and CBD stones between the two groups was also similar. The procedure time was independently associated with post-endoscopic retrograde cholangiopancreatography pancreatitis(OR = 6.374, 95%CI: 1.193-22.624, P = 0.023), CBD stone diameter ≥ 16 mm(OR = 7.463, 95%CI: 2.705-21.246, P = 0.0452) and use of mechanical lithotripsy(OR = 9.913, 95%CI: 3.446-23.154, P = 0.0133) were independent risk factors for stone recurrence. CONCLUSION EPLBD with m EST is more effective than EST alone for difficult CBD stone removal, with shorter procedure time and fewer early complications.

Long-term outcomes of endoscopic papillary balloon dilation for removal of bile duct stones in Billroth Ⅱ gastrectomy patients

Background： Endoscopic papillary balloon dilation （EPBD） for common bile duct （CBD） stones removal in Billroth II gastrectomy patients is feasible. However, the long-term outcomes of this technique are notclear. The aim of this study was to evaluate the procedural and long-term outcomes of EPBD for removal of CBD stones in Billroth II gastrectomy patients.

Outcome of nephrostomy balloon dilation for vesicourethral anastomotic strictures following radical prostatectomy： a retrospective study

To evaluate the efficacy of nephrostomy balloon dilation （NBD） for patients who developed vesicourethral anastomotic stricture （VAS） following radical prostatectomy. NBD was performed in patients who developed VAS following radical prostatectomy. Quality of life （QoL）, International Prostate Symptom Score （IPSS） and maximal urinary flow rate （Qmax） were evaluated. Four hundred and sixty-three prostate cancer patients underwent radical retropubic prostatectomy （RRP）, and 86 underwent laparoscopic radical prostatectomy （LRP）. Most patients （90.3%） had T2 or T3 prostate cancer and a pathological Gleason score of ; 7. Forty-five （8.2%） and four （4.7%） patients developed VAS due to radical or LRP, respectively. Forty （89%） patients underwent NBD, including three cases of repeat dilation. The median Qmax was 4 ml s- （interquartile range （IQR）, 2.3-5.6） before dilation and improved to 16 ml s- （IQR, 15-19） and 19 ml s-1 （IQR, 18-21） at the 1- and 12-month follow-up, respectively （P〈 0.01）. Fifteen （37.5%） patients had urinary incontinence prior to dilation, whereas only three （7.5%） patients had incontinence 12 months following dilation （P 〈 0.01）. The median IPSS score improved from 19 （IQR, 17-24） before dilation to 7 （IQR, 6-8） at 12 months following dilation, and the QoL score improved from 5 （IQR, 4-6） before dilation to 2 （IQR, 2-3） at 12 months following dilation （P 〈 0.01 in both）. VAS occurs in a small but significant proportion of patients following radical prostatectomy. NBD offers an effective remedy for VAS.

Fecal marker levels as predictors of need for endoscopic balloon dilation in Crohn's disease patients with anastomotic strictures

AIM To evaluate the accuracy and best cut-off value of fecal calprotectin(FC) and fecal lactoferrin(FL) to predict disease recurrence in asymptomatic patients presenting with anastomotic strictures. METHODS This was a longitudinal single tertiary center study based on prospectively collected data(recorded in a clinical database created for this purpose) performed between March 2010 and November 2014. Crohn's disease(CD) patients with anastomotic stricture who submitted to postoperative endoscopic evaluation were included. Stools were collected on the day before bowel cleaning for FC and FL. Endoscopic balloon dilation(EBD) was performed if the patient presented an anastomotic stricture not traversed by the colonoscope, regardless of patients' symptoms. Successful dilation was defined as passage of the colonoscope through the dilated stricture into the neotermimal ileum.Postoperative recurrence was defined as a modified Rutgeerts score of ≥ i2 b. RESULTS In a total of 178 patients who underwent colonoscopy, 58 presented an anastomotic stricture, 86% were asymptomatic, and 48(54% male; median age of 46.5 years) were successfully dilated. Immediate success rate was 92% and no complications were recorded. FC and FL levels correlated significantly with endoscopic recurrence(P < 0.001) with an optimal cut-off value of 90.85 μg/g(sensitivity of 95.5%, specificity of 69.2%, positive predictive value(PPV) of 72.4%, negative predictive value(NPV) of 94.7% and accuracy of 81%] for FC and of 5.6 μg/g(sensitivity of 77.3%, specificity of 69.2%, PPV of 68%, NPV of 78.4% and accuracy of 72.9%) for FL.CONCLUSION Fecal markers are good predictors of CD endoscopic recurrence in patients with asymptomatic anastomotic stricture. FC and FL may guide the need for EBD in this context.

Endoscopic balloon dilation for management of stricturing Crohn’s disease in children

BACKGROUND Crohn’s disease(CD)has a multitude of complications including intestinal strictures from fibrostenotic disease.Fibrostenotic disease has been reported in 10%-17%of children at presentation and leads to surgery in 20%-50%of cases within ten years of diagnosis.When symptoms develop from these strictures,the treatment in children has primarily been surgical resection.Endoscopic balloon dilation(EBD)has been shown to be a safe and efficacious alternative to surgery in adults,but evidence is poor in the literature regarding its safety and efficacy in children.AIM To evaluate the outcomes of children with fibrostenosing CD who underwent EBD vs surgery as a treatment.METHODS In a single-center retrospective study,we looked at pediatric patients(ages 0-18)who carry the diagnosis of CD,who were diagnosed after opening a dedicated Inflammatory Bowel Disease clinic on July 1,2012 through May 1,2019.We used diagnostic codes through our electronic medical record to identify patients with CD with a stricturing phenotype.The type of intervention for patients’strictures was then identified through procedural and surgical billing codes.We evaluated their demographics,clinical variables,whether they underwent EBD vs surgery or both,and their clinical outcomes.RESULTS Of the 139 patients with CD,25(18%)developed strictures.The initial intervention for a stricture was surgical resection in 12 patients(48%)and EBD in 13 patients(52%).However,4(33%)patients whom initially had surgical resection required follow up EBD,and thus 17 total patients(68%)underwent EBD at some point in their treatment process.For those 8 patients who underwent successful surgical resection alone,4 of these patients(50%)had a fistula present near the stricture site and 4(50%)had strictures greater than 5 cm in length.All patients who underwent EBD had no procedural complications,such as a perforation.Twenty-two(88%)of the treated strictures were successfully managed by EBD and did not require any further surgical intervention during our follow up period.CONCLUSION EBD is safe and efficacious as an alternative to surgery for palliative management of strictures in selected pediatric patients with CD.

Treatment of hepatic venous stenosis by transfemoral venous balloon dilation following living donor liver transplantation:a case report

Hepatic venous stenosis may be a cause of graft failure in living donor liver transplantation （LDLT）. Balloon dilation and metallic frame approaches have been used successfully to treat hepatic venous stenosis. Here, we report the effect of transfemoral venous balloon dilation for treating a child with hepatic venous stenosis after LDLT .

Endoscopic balloon dilation of crohn's disease stricturessafety,efficacy and clinical impact

AIM To evaluate the incidence of anastomotic strictures after intestinal resection in Crohn's disease(CD), demonstrate long-term efficacy and safety of endoscopic balloon dilation(EBD) in CD strictures and its impact on the diagnosis of subclinical postoperative endoscopic recurrence. METHODS Retrospective single tertiary center study based on prospectively collected data between 2010 and 2015including anastomotic and non-anastomotic strictures. RESULTS29% of 162 CD patients included developed an anastomotic stricture. 43 patients with anastomotic strictures and 37 with non-anastomotic strictures underwent EBD; technical success was 97.7% and 100%, respectively, however, 63% and 41% needed repeat dilation during the 4.4-year follow-up. Longer periods between surgery and index colonoscopy and higher lactoferrin levels were associated with the presence of stricture after surgery. Calprotectin levels > 83.35 μg/g and current or past history of smoking were associated with a shorter time until need for dilation(HR = 3.877, 95%CI: 1.480-10.152 and HR = 3.041, 95%CI: 1.213-7.627). Anastomotic strictures had a greater need for repeat dilation(63% vs 41%, P = 0.047). No differences were found between asymptomatic and symptomatic cohorts. Disease recurrence diagnosis was only possible after EBD in a third of patients. CONCLUSION EBD is an effective and safe alternative to surgery, with a good short and long-term outcome, postponing or even avoiding further surgery. EBD may allow to diagnose disease recurrence in patients with no clinical signs/biomarkers of disease activity.

Feasibility of endoscopic papillary large balloon dilation to remove difficult stones in patients with nondilated distal bile ducts

BACKGROUND Current guidelines recommend not performing papillary large balloon dilation in patients with nondilated distal bile ducts.AIM To assess the feasibility of balloon dilation to remove difficult stones in patients with nondilated distal bile ducts.METHODS Data from 1289 endoscopic retrograde cholangiopancreatography(ERCP)procedures were obtained from two prospective studies.While 258 cases had difficult stones(>1 cm,multiple>8,impacted,or having a thin distal duct),191 underwent biliary dilation up to 15 mm after endoscopic sphincterotomy.Cholangiographies of these cases were retrospectively reviewed in order to classify the distal bile duct and both the stone size and number.Primary outcomes were clearance rate at first ERCP and complications.RESULTS Of the 191 patients(122 women and 69 men;mean age:60 years)who underwent biliary dilation for difficult stones,113(59%)had a nondilated or tapered distal duct.Patients with a dilated distal duct were older than those with nondilated distal ducts(mean 68 and 52 years of age,respectively;P<0.05),had more stones(median 4 and 2 stones per patient,respectively;P<0.05),and had less need for additional mechanical lithotripsy(6.4%vs 25%,respectively;P<0.05).Clearance rate at first ERCP was comparable between patients with a dilated(73/78;94%)and nondilated distal ducts(103/113;91%).Procedures were faster in patients with a dilated distal duct(mean 17 vs 24 min,respectively;P<0.005).Complications were similar in both groups(6.4%vs 7.1%,respectively).CONCLUSION Large balloon dilation for difficult stones is feasible in patients with a nondilated or even tapered distal duct.

A Preliminary Study on the Effect Evaluation of Electroacupuncture Combined with Balloon Dilation in the Treatment of Dysphagia after Cerebral Infarction

Objective: Dysphagia is a frequent symptom caused by cerebral infarction. This study investigated the effect evaluation and safety of electroacupuncture combined with balloon dilatation on dysphagia after cerebral infarction. Methods: Totally 100 patients with dysphagia after cerebral infarction were enrolled as study subjects and assigned into the control group (treated with balloon dilatation) and the observation group (treated with electroacupuncture and balloon dilatation), with 50 cases in each group. The general data of participants were recorded. Before or after treatment, swallowing function was assessed by water swallow test, standardized swallowing function assessment (SSA), videofluoroscopic swallow study (VFSS), and functional oral intake scale (FOIS). The cerebral hemodynamics, serological indicators, neurological impairment, quality of life (QOL) score were analyzed. Additionally, the occurrence of complications and adverse reactions after treatment was assessed. Results: There was no significant difference in gender, age, BMI, course of disease, and grade of dysphagia between the two groups. Balloon dilatation alone and electroacupuncture combined with balloon dilatation decreased the water swallow test, SSA, and VFSS scores, increased FOIS score, and improved the swallowing function, cerebral hemodynamic parameters, serological indicators, neurological function and QOL, with the better efficacy in the combined therapy. Moreover, combined therapy had lower incidences of complications and adverse reactions than balloon dilatation therapy alone. Conclusion: Electroacupuncture intervention combined with balloon dilatation therapy ameliorates swallowing function, cerebral hemodynamics, serological indicators, neurological function and QOL, and reduces complications and adverse reactions in dysphagia after cerebral infarction.

Endoscopic papillary large balloon dilation alone or combined with small or complete sphincterotomy for the removal of large common bile duct stones

Background:Endoscopic papillary large balloon dilation(EPLBD)has been proposed as an alternative to manage large bile duct stones.However,EPLBD alone or combined with sphincterotomy remains controversial.Methods:Between Jan.2014 and Dec.2017,195 consecutive patients with proven large common bile duct stones(size≥10 mm)were retrospectively analyzed.We compared the baseline characteristics,procedure time,success rate of stone removal and morbidity outcomes in different groups.Results:There were no significant difference between baseline characteristics of the groups compared.A total of 89.2%,95.4%,and 93.8% of the patients in the EPLBD,EPLBD+small sphincterotomy(SES),and EPLBD+complete sphincterotomy(CES)groups had stones cleared(P=0.473),respectively.There was no difference in terms of procedure time(33.5±10.2,34.8±9.0,34.9±8.2,in the EPLBD,EPLBD+SES,and EPLBD+CES groups,respectively).However,when assigned to tvvo groups according to bile duct stones diameter(bile duct stones<13 mm,bile duct stones≥13 mm).in the bile duct stones<13 mm group,the procedure time was significantly less in the EPLBD group than the EPLBD+SES group and the EPLBD+CES group(P=0.028).In the bile duct stones≥13 mm group,the mechanical lithotripsy rate of EPLBD was significantly higher compared to EPLBD+SES or EPLBD+CES(P=0.032).The complication rates were similar among all groups.Conclusions:The diameter of bile duct stones should be taken into consideration when choosing EPLBD alone or combined with small sphincterotomy for the removal of common bile duct stones.

The status of Eustachian tube balloon dilations in Nordic countries

There is no unanimous consensus for indications of eustachian tube balloon dilation(ETBD).Nordic countries have relatively similar hospital organizations and treatment guidelines.Therefore,it was logical to organize a consensus meeting of ETBD.The symposium:Nordic Experiences on Eustachian Tube Balloon Dilation,in Copenhagen,30-31 March,2017.The panellists from Denmark,Finland,Norway and Sweden and the attendees of the meeting agreed a consensus on the following issues:Candidates,Definition of Eustachian Tube Dysfunction,Diagnostic Work up,Differential Diagnosis,Contraindications,ETBD Procedure,Complications,Follow-up,and Outcomes.The article also presents the status for ETBD in each of these countries.Thereafter the consensus statement has been discussed in the national societies and meetings for ear surgeons in each of these countries.It can be assumed that surgeons in the hospitals of these Nordic countries generally follow the recommendations from the consensus meeting.

In-office balloon dilation of the Eustachian tube under local anesthesia: A retrospective review

Objective:To study the effectiveness and feasibility of in office balloon dilation of the Eustachian tube(BDET)utilizing a novel anesthetic protocol.Study design:retrospective review.Methods:Retrospective chart review looking at the tolerability and effectiveness of standalone BDET in an office setting utilizing a novel topical anesthesia protocol in 33 patients with Eustachian tube dysfunction as defined by an ETDQ-7 score greater than 2.2 and type B or C tympanograms for greater than 3 months despite maximal medical management,including at least 4 weeks of nasal steroids.Results:BDET in the office was well tolerated with 94%(31/33)of patients completing the procedure as planned.No adverse effects or complications were reported;however,the planned dilation time was cut short in one case due to significant discomfort and aborted prior to dilation in another due significant coughing.Tympanograms normalized at six weeks in 87.1%(27/31)of patients who underwent dilation.Conclusion:This study demonstrates that performing BDET in an office setting utilizing a local anesthesia protocol is feasible and effective when the unique barometric considerations of BDET are addressed.

经鼓室口咽鼓管球囊扩张术的疗效及咽鼓管功能的影响

目的探讨经鼓室口咽鼓管球囊扩张(balloon dilatation Eustachian tuboplasty,BET)联合腺样体消融术对慢性分泌性中耳炎(chronic secretory otitis media,CSOM)患儿的疗效及咽鼓管功能的影响。方法选取2020年6月~2022年12月间在中山市小榄人民医院就诊的CSOM患儿82例作为研究对象,采用随机数字表法分为对照组和观察组,每组41例。对照组接受腺样体消融术+鼓膜切开置管术治疗,观察组接受腺样体消融术+鼓膜切开置管术+BET术。比较两组手术相关指标及住院时间、临床症状、咽鼓管功能、临床疗效及随访6个月并发症及复发情况。结果两组术中出血量比较,差异无统计学意义(P>0.05),与对照组相比,观察组手术时间更长,住院时间更短(P<0.05)。与对照组相比,观察组中耳积液消失时间、耳鸣消失时间、鼓膜愈合时间、听力恢复时间均更短(P<0.05)。与治疗前相比,治疗后两组咽鼓管评分(Eustachian tube score,ETS)升高、咽鼓管功能障碍评分量表(Eustachian tube dysfunction questionnaire-7,ETDQ-7)评分降低(P<0.05),观察组ETS评分高于对照组,ETDQ-7评分则低于对照组(P<0.05)。观察组临床总有效率高于对照组,差异具有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(14.63%vs.9.76%,P>0.05),与对照组相比,观察组复发率更低,差异具有统计学意义(21.95%vs.2.44%,P<0.05)。结论经鼓室口BET联合腺样体消融术有助于提高CSOM患儿的临床疗效,改善咽鼓管功能,促进术后恢复,减少复发率,且并发症发生率低。

Endoscopic treatment of extreme esophageal stenosis complicated with esophagotracheal fistula: A case report

BACKGROUND At present,there is no unified and effective treatment for extreme corrosive esophageal stenosis(CES)with esophagotracheal fistula(ETF).This case had extreme and severe esophageal stenosis(ES)and ETF after ingesting an enzyme-based chemical detergent,resulting in a serious pulmonary infection and severe malnutrition.Upper gastrointestinal imaging showed that he had an ETF,and endoscopy showed that he had extreme and severe esophageal stricture.This case was complex and difficult to treat.According to the domestic and foreign lite-rature,there is no universal treatment that is low-risk.CASE SUMMARY A patient came to our hospital with extreme ES,an ETF,and severe malnutrition complicated with pulmonary tuberculosis 1 mo after the consumption of an enzy-me-based detergent.The ES was serious,and the endoscope was unable to pass through the esophagus.We treated him by endoscopic incision method(EIM),esophageal stent placement(ESP),and endoscopic balloon dilation(EBD)by using the bronchoscope and gastroscope.This treatment not only closed the ETF,but also expanded the esophagus,with minimal trauma,greatly reducing the pain of the patient.According to the literature,there are no similar reported cases.CONCLUSION We report,for the first time,a patient with extreme CES complicated with ETF,where the endoscope could not be passed through his esophagus but he could be examined by bronchoscopy and treated by EIM,ESP,and EBD.

Dilation assisted stone extraction for complex biliary lithiasis:Technical aspects and practical principles

Common bile duct stones are frequently diagnosed worldwide and are one of the main indications for endoscopic retrograde cholangio-pancreatography.Endoscopic sphincterotomy(EST)has been used for the removal of bile duct stones for the past 40 years,providing a wide opening to allow extraction.Up to 15%of patients present with complicated choledocholithiasis.In this context,additional therapeutic approaches have been proposed such as endoscopic mechanical lithotripsy,intraductal or extracorporeal lithotripsy,or endoscopic papillary large balloon dilation(EPLBD).EPLBD combined with EST was introduced in 2003 to facilitate the passage of large or multiple bile duct stones using a balloon greater than 12 mm in diameter.EPLBD without EST was introduced as a simplified technique in 2009.Dilation-assisted stone extraction(DASE)is the combination of two techniques:EPLBD and sub-maximal EST.Several studies have reported this technique as safe and effective in patients with large bile duct stones,without any increased risk of adverse events such as pancreatitis,bleeding,or perforation.Nevertheless,it is difficult to analyze the outcomes of DASE because there are no standard techniques and definitions between studies.The purpose of this paper is to provide technical guidance and specific information about the main issues regarding DASE,based on current literature and daily clinical experience in biliary referral centers.

Isoproterenol Stress Echocardiography in Assessing Mitral Valve Area Reserve before and after Percutaneous Balloon Valvuloplasty

Objective To determinewhether successful valvuloplasty causes an increase of mitral valve area reserve in patients with mitral stenosis, isoproterenol stress echocardiography was used to compare mitral valve area and hemodynamic changes between pre - and post - valvuloplasty under conditions of increased cardiac work. Methods Thirty-eight patients with pure rheumatic mitral stenosis who had received successful percutaneous balloon valvuloplasty underwent isoproterenol stress echocardiography pre- and post - valvuloplasty. Mitral valve area (by direct planimetry of two - dimensional echocardiography), mean transmitral pressure gradient (by continuous-wave Doppler echocardiography), and cardiac output (by M-mode echocardiography) were measured at rest and under isoproterenol stress to achieve heart rate of different stages. Results Mitral valve area (0.91±0.28 to 1.87±0.23 cm2, P<0. 01), mean transmitral pressure gradient (12. 5±6. 3 to 3. 9± 1. 9 mmHg, P < 0. 01) and cardiac output (3. 93± 1. 44 to 4. 73±1. 01 L/min, P < 0. 05) at rest between pre - and post - valvuloplasty were significantly different. Pre - valvuloplasty, as heart rate increased under stress, mean transmitral pressure gradient increased significantly ( P < 0. 01), but there were no significant differences in the measurements of mitral valve area and cardiac output (both P>0. 05) . In contrast, as heart rate increased post-valvuloplasty, there was a significant increase in mean transmitral pressure gradient (P<0.01), but both mitral valve area and cardiac output further increased significantly (bothP<0. 01) . Moreover, valvuloplasty decreased mean transmitral pressure gradient at peak heart rate from 23. 0±4. 5 to 7. 75 ± 2. 30 mmHg ( P < 0. 01) under submaximal stress. Conclusions Successful percutaneous balloon valvuloplasty soon causes a significant increase of mitral valve area reserve in patients with mitral stenosis, which is markedly manifested under conditions of hemodynamic stress. Stress echocardiog-raphy provides a safe, feasible and non-invasive means of assessing this reserve capacity.

Predictors of outcomes of endoscopic balloon dilatation in strictures after esophageal atresia repair: A retrospective study

BACKGROUND Endoscopic balloon dilatation (EBD) has become the first line of therapy for benign esophageal strictures (ESs);however,there are few publications about the predictive factors for the outcomes of this treatment.AIM To assess the predictive factors for the outcomes of EBD treatment for strictures after esophageal atresia (EA) repair.METHODS Children with anastomotic ES after thoracoscopic esophageal atresia repair treated by EBD from January 2012 to December 2016 were included.All procedures were performed under tracheal intubation and intravenous anesthesia using a three-grade controlled radial expansion balloon with gastroscopy.Outcomes were recorded and predictors of the outcomes were analyzed.RESULTS A total of 64 patients were included in this analysis.The rates of response,complications,and recurrence were 96.77%,8.06%,and 2.33%,respectively.The number of dilatation sessions and complications were significantly higher in patients with a smaller stricture diameter (P=0.013 and 0.023,respectively) and with more than one stricture (P=0.014 and 0.004,respectively).The length of the stricture was significantly associated with complications of EBD (P=0.001).A longer interval between surgery and the first dilatation was related to more sessions and a poorer response (P=0.017 and 0.024,respectively).CONCLUSION The diameter,length,and number of strictures are the most important predictive factors for the clinical outcomes of endoscopic balloon dilatation in pediatric ES.The interval between surgery and the first EBD is another factor affectingresponse and the number of sessions of dilatation.

Balloon dilatation for treatment of hepatic venous outflow obstruction following pediatric liver transplantation

AIM To assess the efficacy and safety of balloon dilatation for the treatment of hepatic venous outflow obstruction(HVOO) following pediatric liver transplantation.METHODS A total of 246 pediatric patients underwent liver transplantation at our hospital between June 2013 and September 2016. Among these patients, five were ultimately diagnosed with HVOO. Seven procedures(two patients underwent two balloon dilatation procedures) were included in this analysis. The demographic data,types of donor and liver transplant, interventional examination and therapeutic outcomes of these five children were analyzed. The median interval time between pediatric liver transplantation and balloon dilatation procedures was 9.8 mo(range: 1-32).RESULTS Five children with HVOO were successfully treated by balloon angioplasty without stent placement, with seven procedures performed for six stenotic lesions. All children underwent successful percutaneous intervention. Among these five patients, four were treated by single balloon angioplasty, and these patients did not develop recurrent stenosis. In seven episodes of balloon angioplasty across the stenosis, the pressure gradient was 12.0 ± 8.8 mm Hg before balloon dilatation and 1.1 ± 1.5 mm Hg after the procedures, which revealed a statistically significant reduction(P < 0.05). The overall technical success rate among these seven procedures was 100%(7/7), and clinical success was achieved in all five patients(100%). The patients were followed for 4-33 mo(median: 15 mo). No significant procedural complications or procedurerelated deaths occurred.CONCLUSION Balloon dilatation is an effective and safe therapeutic option for HVOO in children undergoing pediatric liver transplantation. Venous angioplasty is also recommended in cases with recurrent HVOO.