In 1964, an American radiologist CharlesBostone conducted the first balloon catheterization tests. 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 treatment method in which stenosis or anastomosis in the hollow organ is eliminated by stretching the stenotic area with a special balloon that swells inside the constriction. The procedure is endoscopic and is used by surgeons for pathologies of the gastrointestinal tract, trachea and bronchi, for diseases of the vessels of the heart, aortic valve, coronary heart disease, hearing organs, etc.
Application of the method for coronary heart disease
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 whole procedure for moving the balloon through the vessel is controlled on the screen of the x-ray machine.
To avoid the appearance of a blood clot in the dilated vessel, antiplatelet agents are prescribed. The success of the method is guaranteed in 80% of cases.
In what cases is it performed?
It is possible to treat narrowing in this way of any artery. For example, with intermittent claudication, ischemic heart disease, aortic valve stenosis, etc.
Contraindications
In the presence of a large number of narrowing places 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 vessels of the heart dangerous?
A catheter is inserted into the femoral artery. The 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 time of expansion of the vessel, the blood circulation of the heart may deteriorate, which is fraught with the development of a heart attack.
A complication of this type is rare, but requires preventive measures. Today, balloon dilatation is one of the effective methods of treating coronary artery disease. If arterial bleeding occurs, it is easily eliminated.
Heart valve expansion
This refers to a narrowing of the aortic valve. Previously, such a pathology required complex heart surgery, but today a balloon is inserted into the valve lumen and under pressure it inflates, expanding the narrowing of the valve. When narrowing the pelvic arteries and lower extremities, balloon dilatation is also widely used.
Esophagus dilatation
An endoscopic procedure for expanding the esophagus is used for:
- stenosis;
- cicatricial strictures;
- the formation of rings of connective tissue;
- achalasia cardia;
- strictures of esophageal anastomoses after esophagoplasty.
Non-invasive esophageal balloon dilatation gives very good results. All details of the process are visualized by a special camera or by fluoroscopy.
Cicatricial strictures of the esophagus in large quantities occur most often with burns of various etiologies, radiation therapy, as a result of reflux esophagitis, benign neoplasms. Balloon dilatation is used for narrowing less than 9 mm. Oncology should be excluded. The operation is always planned.
Stomach diseases
Indications for the procedure:
- Benign diseases of the stomach in the absence of another type of treatment.
- Stenoses of the output sections of the stomach and duodenum due to ulcerative lesions.
- Mucosal resection.
- Burn and organic strictures.
- As a palliative measure to restore patency in tumors.
- Pylorospasm after surgery of the upper gastrointestinal tract.
Bowel problems
Dilation is recommended in the following cases:
- Education of a benign nature.
- Strictures after inflammation (diverticulitis, UC, Crohn's disease).
- Intestinal adhesions.
- With oncology to restore bowel obstruction.
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 gall bladder (congenital or post-inflammatory with cholangitis, pancreatitis).
- Malignant strictures (balloon dilatation is used before installing a plastic stent for the purpose of expansion).
Respiratory system
With 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.
- The use of mechanical ventilation and intubation, burns of the respiratory tract or prolonged stuck in the lumen of the bronchus of a foreign body.
- 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.
- Non-correctable bleeding in areas of suspected extensions.
- Blockage of the lumen of the esophagus (it is impossible to enter the balloon).
- Oncology for which radical treatment will be applied.
- Condition after MI or stroke.
- Hypertension in the portal vein system.
Preparation for dilatation
It is mandatory to rinse the esophagus and stomach 6 hours before the manipulation, and for 5-6 hours, the exclusion of antiplatelet agents. It is excluded for 12 hours a meal, and 6 hours before the procedure, drinking liquid. Blood coagulability, anesthesia tolerance and the presence of infection in the blood are checked. Balloon dilatation is always performed on an empty stomach.
How is the procedure performed?
Endoscopic balloon dilatation requires the use of a small diameter endoscope. It consists of a long catheter, at its end the balloon is in a folded state.
For expansion, a liquid is injected into it with a special tool with the creation of a certain pressure. The balloon is stretched to the desired diameter.
Inflation is carried out when the balloon is localized in the stricture zone, which increases its clearance. The residence time of the balloon is up to 2-3 minutes, then it is deflated and removed.
Dilation begins with small sizes of cylinders (10 mm) and is gradually replaced by large ones - up to 20 mm. With a stricture of the esophagus, a catheter is inserted through the nose, the diameter is not more than 5 mm, with bowel stenosis - 8-9 mm.
Esophagus balloon manipulations are performed under local anesthesia, but mild soreness is not excluded. Local anesthetic is a 10% lidocaine spray. The nebulizer is aimed at the posterior pharyngeal wall, and a sedative such as Relanium is additionally administered. With the introduction of the tube, 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 squeezing of the throat and chest. The balloon according to the situation can inflate several times.
How is balloon dilatation with fibrocolonoscopy performed? The procedure is possible only after an enema of the intestine. The technique of preparation otherwise does not differ from manipulations on other organs.
Advantages of the method for the treatment of esophageal pathologies
The risk of complications is negligible, according to statistics, there is a minimum of injuries.
The disadvantages include the need for repeated expansion, several repeated manipulations in the process.
Esophageal balloon dilatation reviews are mostly positive. Statistics show a low percentage of relapses. Patients note that they were able to completely get rid of existing ailments.
A balloon for dilatation in pathologies of the biliary system is injected endoscopically or transdermally, transhepally.
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 be no increase in stenosis by more than 1-2 mm.
Then, the interval between procedures will be extended to 10-14 days, then once every 3 weeks. In the absence of stenosis - 1 time per month. Supportive treatment thus takes from 3 to 6 months. Dynamics monitoring is carried out once a year.
Possible complications
Since manual control of the force from the balloon to the tissues is impossible, there is a chance of damage to the organ wall with its tear. Therefore, they apply the extension gradually. Blood leakage may also occur, but it stops on its own.
The most serious complication is organ wall perforation, which requires closure surgery.
Rehabilitation period
It is advisable to observe a doctor in the first 4 days after the procedure to exclude any complications. Limitations:
- do not drink anything in the first 2-3 hours after dilatation;
- solid food is allowed only the next day.
It is urgent to consult a doctor if:
- feces turned black and there is an admixture of blood;
- difficulty breathing and swallowing;
- fever and chills;
- pain in the sternum.
The results of endoscopy Research Institute of Oncology. N. N. Petrova
Reviews about balloon dilatation by doctors are pretty encouraging. They successfully practice this method of therapy. Daily balloon dilatations of strictures of various organs result in successful cure of the patient in 95% of cases. This is more than a good result.
Auditory tube and balloon dilatation
The author of the unique technology is considered to be German professor Martin Koch from the city of Hanover. After such an operation, patients immediately notice an improvement in hearing.
He points out that his technique for balloon dilatation of the auditory tube has proven positive results. The pressure in the middle ear is equalized, ventilation is fully restored. In 85% of cases, it is possible to eliminate the symptoms of otitis media (exudate in the ear, feelings of congestion and noise disappear) and hearing improves.
There was no need for repeated dilations. Operations are performed at any age of the patient, even in young children.
Anatomical studies have shown that only the cartilaginous part of the auditory tube expands. It is absolutely safe.
The results last long: after 1 year in 95% of patients, hearing improves, 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 fatalities have been reported.
In 2015, a balloon dilatation of the auditory tube was performed in Russia for the first time in a clinic at the Department of Otorhinolaryngology of the Moscow State Medical University. I.P. Pavlova in St. Petersburg.
Auditory tube concepts
An auditory or Eustachian tube connects the nasopharynx and middle ear. Through it, air enters the tympanum, so the pressure on both sides of the membrane becomes the same.
In addition, conducting sound vibrations to the corresponding receptors is normal. With a narrow clearance, all this is broken. Dilation is indicated with the ineffectiveness of conservative treatment. A valuable property of balloon dilatation of the auditory tube is the fact that the outflow of inflammatory secretion from the middle ear is facilitated.
Technique
For dilatation, a disposable balloon catheter is inflated with saline to P = 10 atmospheres in the cartilaginous part of the auditory tube. In this case, the cylinder reaches a diameter of 3.28 mm. To conduct a catheter to the pharyngeal orifice of the auditory tube, a reusable instrument with interchangeable tips curved at an angle of 30 °, 45 °, 70 °, 90 ° is used.
A catheter is inserted intranasally at an angle of inclination of the individual anatomy of the patient. The tool has a limiter, which prevents the catheter from getting into the bone section of the tube.
The exposure time of the balloon is 2 minutes, and the duration of the entire operation is no more than 20 minutes. Anesthesia is used endotracheal. Patient discharge occurs after 2 days. Control examinations are carried out after 1, 6, 12 months.
The balloon dilation of the auditory tube reviews is 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 media decreased gradually. Repeated dilations are usually not required. No complications are observed.
Indications for the procedure:
- chronic tubular dysfunction;
- lack of ventilation in the auditory tube;
- often recurrent exudative otitis media with no shunt effect;
- stage of mucosis with exudative otitis media.
Contraindications:
- deviations in the psyche;
- Down's disease;
- cicatricial narrowing of the Eustachian tube, stenosis of the bony part of the passage.
When selecting candidates for dilatation, ear microscopy, tympanography and audiometry, endoscopic examination of the nasopharynx and CT are mandatory.