Stomach

• Strictures of the stomach usually occur as a complication of a surgical procedure, such as gastroenterostomy or gastric stapling for morbid obesity.  Reports indicate that strictures occur in 4 - 6% of patients with gastric anastomoses.  Balloon dilations have proven to be an effective method of treatment for these strictures. In most instances, the procedure can be performed entirely under fluoroscopic control; however, in some cases it may be difficult to cross the stricture with a guide wire to initiate the procedure.  It may be particularly difficult to negotiate an anastomotic stricture under fluoroscopic guidance if the stenosis is severe.  In addition, when the proximal gastric remnant of the gastroenterostomy is relatively large, this portion of the gut gives little side support for the catheter during the attempt to cross the gastrojejunal anastomosis.  Therefore, in some cases, a combined endoscopic-fluoroscopic approach may be helpful. The initial passage of the guide wire into the stricture may be performed more easily under direct vision with an endoscope.  After the wire has been placed across the stricture under direct visualization, the procedure can be continued under fluoroscopic guidance, which allows better control of the balloon dilation procedure and reduces the risk of perforation.
  
  

• The procedure is otherwise similar to the basic technique described earlier.  Again, the size of the balloon chosen for the dilation is determined by the original diameter of the anastomosis created at surgery and may range from 15 to 20 mm in diameter.  Also, if the stricture is very narrow or tight, the procedure is started with balloons of small diameter.  Multiple 2-3 minute inflations are usually required to fully stretch the stricture to the maximum desirable diameter.