In 1964, American radiologist CharlesBostone conducted the first tests of balloon catheterization. Today, this technique is used in many branches of medicine. It allows you to avoid complex risky operations and is limited to one-day hospitalization of the patient.
Balloon dilatation is a specific method of treatment in which stenosis or anastomosis in a hollow organ is eliminated by stretching the stenotic area with a special balloon that inflates inside the constriction. The procedure is endoscopic and is used by surgeons for pathologies of the gastrointestinal tract, trachea and bronchi, diseases of the heart vessels, aortic valve, coronary artery disease, hearing organs, etc.
Application of the method for IHD
The use of this method of therapy in cardiology is performed with narrowing of the arteries. The balloon is located at the end of the catheter inserted into the vessel. The entire procedure for moving the balloon through the vessel is controlledon the X-ray screen.
To avoid the appearance of a blood clot in a dilated vessel, antiplatelet agents are prescribed. The success of the method is guaranteed in 80% of cases.
When is it performed?
It is possible to treat the narrowing of any artery in this way. For example, with intermittent claudication, coronary artery disease, aortic valve stenosis, etc.
Contraindications
In the presence of a large number of places of narrowing in advanced cases or with a large length of the stenotic area, dilatation does not give an effect. The same applies to calcified areas of the vascular wall. Then an operation is performed to remove the affected parts of the vessels and replace them with a prosthesis (polytetrafluoroethylene tube).
Is dilatation of the heart vessels dangerous?
The catheter is inserted into the femoral artery. Carrying out balloon dilatation is carried out with simultaneous preparation for open surgery on the affected vessels. This is necessary because there is always a risk that at the moment of expansion of the vessel, the blood circulation of the heart may deteriorate, which is fraught with the development of a heart attack.
This type of complication is rare but requires preventive measures. Today, balloon dilatation is one of the effective methods of treating coronary artery disease. If there is bleeding from an artery, it is easily eliminated.
Dilation of the heart valves
Referring to narrowing of the aortic valve. Previously, with such a pathology, a complex heart operation was required, but today a balloon is inserted into the valve lumen and under pressure it inflates, expanding the narrowing of the valve. With narrowing of the arteries of the pelvis and lowerextremity balloon dilatation is also widely used.
Dilation of the esophagus
Endoscopic esophageal dilation procedure is used for:
- stenosis;
- scar strictures;
- formation of connective tissue rings;
- achalasiacardia;
- strictures of esophageal anastomoses after esophagoplasty.
Non-invasive balloon dilatation of the esophagus gives very good results. All details of the process are visualized with a special camera or fluoroscopy.
Cicatricial strictures of the esophagus in large numbers occur most often with burns of various etiologies, radiation therapy, as a result of reflux esophagitis, and benign neoplasms. Balloon dilatation is used when narrowing is less than 9 mm. Oncology must be ruled out. The operation is always planned.
Stomach diseases
Indications for the procedure:
- Benign gastric disease in the absence of other treatment.
- Stenosis of the outlet sections of the stomach and duodenum due to ulcerative lesions.
- Resection of the mucous membrane.
- Burn and organic strictures.
- As a palliative measure to restore patency in tumors.
- Pylorospasm after upper gastrointestinal surgery.
Intestinal problems
Dilatation is recommended in the following cases:
- Benign lesions.
- Strictures after inflammation (diverticulitis, UC, Crohn's disease).
- Intestinal adhesions.
- In oncology to restore intestinal patency.
Pathologies of the biliary system
In this case, the procedure is necessary in the following cases:
- Benign strictures of the ducts of the pancreas and gallbladder (congenital or post-inflammatory in cholangitis, pancreatitis).
- Malignant strictures (balloon dilatation is used before a plastic stent is placed to expand it).
Respiratory organs
In case of pathologies of the pulmonary system, balloon dilatation will be needed in the following cases:
- Benign formations of the trachea and bronchi, their narrowing after inflammation, after TB.
- Use of ventilation and intubation, burns of the respiratory tract or foreign body stuck in the lumen of the bronchus for a long time.
- Narrowing of tracheobronchial anastomoses after operations.
General contraindications
Prohibitions include the following:
- Significant inflammation and swelling, because of this there is a risk of tissue injury.
- Uncorrected bleeding in areas of alleged dilations.
- Obstruction of the lumen of the esophagus (it is impossible to enter the balloon).
- Oncology for which radical treatment will be applied.
- Post-MI or stroke.
- Hypertension in the portal vein system.
Preparation for dilatation
Rinse is mandatorythe esophagus and stomach 6 hours before the manipulation, and 5-6 hours before the exclusion of antiplatelet drugs. Eating is excluded 12 hours before the procedure, and drinking liquids 6 hours before the procedure. Blood coagulability, tolerance to anesthesia and the presence of infection in the blood are checked. Balloon dilatation is always done on an empty stomach.
How the procedure works
Endoscopic balloon dilatation requires the use of a small diameter endoscope. It consists of a long catheter, at the end of which the balloon is in a collapsed state.
For expansion, a liquid is injected into it with a special tool with the creation of a certain pressure. At the same time, the balloon is stretched to the desired diameter.
Inflation is performed when the balloon is localized in the stricture zone, which increases its lumen. The balloon stays for up to 2-3 minutes, then it is deflated and removed.
Dilatation starts with small sizes of balloons (10 mm) and gradually changes to large ones - up to 20 mm. With esophageal stricture, the catheter is inserted through the nose, the diameter is not more than 5 mm, with intestinal stenosis - 8-9 mm.
Manipulations with the balloon in the esophagus are performed under local anesthesia, but mild pain is not ruled out. Local anesthetic - 10% lidocaine spray. The nebulizer is aimed at the back wall of the pharynx, and a sedative such as "Relanium" is additionally injected. When the tube is inserted, the patient's breathing is not disturbed. Everything is done under x-ray control.
When the balloon is inflated, the patient may feel a slight squeezingthroat and chest. The balloon can be inflated several times depending on the situation.
How is balloon dilatation with fibrocolonoscopy performed? The procedure is possible only after an enema of the intestine. The preparation technique otherwise does not differ from manipulations on other organs.
Advantages of the method for the treatment of pathologies of the esophagus
The risk of complications is negligible, according to statistics, there is a minimum of injuries.
Disadvantages include the need for re-expansion, several repetitive manipulations in the process.
Balloon dilatation of the esophagus reviews are mostly positive. Statistics show a low percentage of relapses. Patients note that they managed to completely get rid of existing ailments.
A balloon for dilatation in pathologies of the biliary system is administered endoscopically or percutaneously, transhepatic.
Duration and frequency of treatment
After the main expansion, balloon dilatation is repeated once a week until a stable result. This means that at the next visit to the doctor there should not be an increase in stenosis by more than 1-2 mm.
Then the interval between treatments will be extended to 10-14 days, then every 3 weeks. In the absence of stenosis - 1 time per month. Maintenance treatment thus takes 3 to 6 months. Monitoring of the dynamics is carried out once a year.
Possible Complications
Because manual force control from the balloon to the tissuesimpossible, there is a possibility of damage to the wall of the organ with its anguish. Therefore, the extension is applied gradually. There may also be bleeding, but it stops on its own.
The most serious complication is perforation of the organ wall, which requires suturing surgery.
Rehabilitation period
It is advisable to observe a doctor in the first 4 days after the procedure to exclude any complications. Restrictions:
- do not drink anything for the first 2-3 hours after dilatation;
- solid food is only allowed the next day.
You should see a doctor immediately if:
- feces turned black and there is an admixture of blood;
- breathing and swallowing difficult;
- fever and chills;
- chest pain.
Results of endoscopy of the Research Institute of Oncology. N. N. Petrova
Reviews about balloon dilatation from doctors are quite encouraging. They successfully practice this method of therapy. Daily balloon dilatations of strictures of various organs result in a successful cure of the patient in 95% of cases. This is more than a good result.
Estachian tube and balloon dilatation
The German professor Martin Koch from the city of Hannover is considered the author of the unique technology. After such an operation, patients immediately notice an improvement in hearing.
He points out that his Eustachian tube balloon dilatation technique has proven positive results. Middle ear pressureis leveled, ventilation is fully restored. In 85% of cases, it is possible to eliminate the symptoms of otitis media (exudate in the ear, stuffiness and noise disappear) and hearing improves.
There was no need for repeated dilations. Operations are performed at any age of the patient, even in small children.
Anatomical studies have shown that only the cartilaginous part of the auditory tube expands. It is absolutely safe.
Results are long lasting: after 1 year, 95% of patients have improved hearing, and after 5 years, it remains in 75%.
Among the complications of balloon dilatation of the auditory tube, purulent otitis media, subcutaneous emphysema can rarely occur, but they are treated conservatively. No deaths reported.
In 2015, balloon dilatation of the auditory tube was performed for the first time in Russia, in the clinic at the Department of Otorhinolaryngology of the State Medical University. I. P. Pavlova in St. Petersburg.
Estachian tube concepts
The auditory or Eustachian tube connects the nasopharynx and the middle ear. Air enters the tympanic cavity through it, so the pressure on both sides of the membrane becomes the same.
Besides, the conduction of sound vibrations to the corresponding receptors is normal. With a narrow gap, all this is broken. Dilation is indicated when conservative treatment fails. A valuable property of balloon dilatation of the auditory tube is that it facilitates the outflow of inflammatory secretions from the middle ear.
Technique
For dilation, a disposable balloon catheter is inflated with saline to P=10 atmospheres percartilaginous part of the auditory tube. In this case, the balloon reaches a diameter of 3.28 mm. To pass the catheter to the pharyngeal mouth of the auditory tube, a reusable instrument with interchangeable tips bent at an angle of 30°, 45°, 70°, 90° is used.
The catheter is inserted intranasally at an angle of inclination of the individual patient's anatomy. The instrument has a limiter that prevents the catheter from entering the bony part of the tube.
The balloon exposure time is 2 minutes, and the duration of the entire operation is no more than 20 minutes. Anesthesia is applied endotracheally. The patient is discharged after 2 days. Control examinations are carried out after 1, 6, 12 months.
Balloon dilatation of the auditory tube reviews are mostly positive. Patients note that the manipulation is easily tolerated. In 95% of patients, hearing improved instantly, and the effect persisted for more than 5 years. Symptoms of exudative otitis decreased gradually. Repeated dilatations are usually not required. Complications are not observed.
Indications for the procedure:
- chronic tubal dysfunction;
- lack of ventilation in the auditory tube;
- frequently relapsing exudative otitis with no bypass effect;
- mucosal stage in exudative otitis.
Contraindications:
- mental deviations;
- Down's disease;
- cicatricial narrowing of the Eustachian tube, stenosis of the bone part of the passage.
When selecting candidates for dilatation, ear microscopy, tympano- and audiometry, endoscopy of the nasopharynx and CT are required.
