Progressive Dilation Balloon Treatment of Esophageal Cardia Stenosis

Progressive Dilation Balloon Treatment of Esophageal Cardia Stenosis

The most effective methods to treat esophageal cardia stricture are Savary–Gilliaid expansion and balloon dilation. Balloon dilation exerts a spreading pressure on the lesion and it could be effective both in short-term and long-term. It is widely applied in clinical application also due to its easy operation and less complication.

The progressive dilation balloons have collected the advantages of both wire-guided balloons and endoscopic balloons. Nevertheless, it could be dilated to different size under different pressure. (Pay attention to the flag on the product and choose the diameter ATM you look for).

After dilate the stenosis, the balloon is deflated. It has low-profile design which means when pressure is discharged, it is with small diameter and could be retreated from the endoscopic channel.

In clinical treatment, the physicians do not need to change balloon of different sizes. Rare complications are found in clinical application. The balloons are also applicable for pyloric and colonic stenosis dilation.

Treatment of achalasia

Achalasia (AC) is also called cardia spasm. It has symptoms like weight loss, dysphagia, reflux, back rib pain and upper abdominal pain, which has very annoying influence on patient’s life quality. The occurrence rate in China is one in 100,000 population. Most patients are below age 50.

Presently, we have multiple treatments for this disease, such as Botox injection, minimally incision of the muscle, and dilation treatment.  

Metal stent, balloon and aqueous capsule are different choices of dilation.

Balloon dilation is to exert mechanic force on the cardia muscle, which leads to the laceration of the cardia mucosa. The pressure on lower esophageal sphincter is reduced and the obstruction is relieved. Considering the long-term treatment effect, progressive dilation balloons and retrievable stents are preferred in clinical application.

Tips for stent implantation:

Stent is suggested to be retrieved within 2-3 weeks, maximum 60 days after implantation. Long term stenting is related with more complications such as granulation growth or cicatricial stenosis.

Instructions of progressive balloon dilation:

Perform pharyngeal surface anesthesia and insert gastro endoscope. Make suction to get clear vision. Penetrate the guide wire through the endoscopic channel into the gastric cavity. Under the vision of endoscope, insert the balloon dilation catheter. When the balloon is located at the cardia, dilate the balloon with gas. Keep the balloon on the cardia place. Each time APM is elevated, wait 3 minutes until next elevation. When it reaches 3 APM, keep the balloon and wait 10 minutes. Observe under endoscope and see laceration at two or four positions. This indicates that operation is successful.

Discharge the gas and retreat the balloon and endoscope.

Food is forbidden after operation and supply acid suppression agent.

  Comparing with other treatment , balloon dilation is regarded as the most useful treatment in clinical application. Botox injection only take effect at short term and the disease shall occur again. Stent implantation is also easy to operate, while it has complications requiring massive observation and careful treatment. The effect shall also diminish when the stent is removed. Progressive balloon has good operational effect in the long term. The mechanicalexpansion cause laceration of the mucosa and sphincter. Part of the muscle in the cardialoses expansion force. The effective term is longer and thus more effective. After the treatment, the patient’s swallowing difficulty and chest pain are enormously alleviated. From the perspective of operational safety, less pain to the patient and effectiveness duration, progressive balloon is better than stent in treating achalasia.