Endoscopic Balloon Dilation of a Benign Duodenal Stenosis

Experienced teaching points

Clinical Pearls

Guidewire placement is necessary for safe endoscopic balloon dilation of duodenal stenoses to prevent distal perforation.
Direct endoscopic visualization during balloon inflation allows for real-time monitoring of mucosal changes.
Water is a practical and effective inflation medium for balloon dilation without fluoroscopy.
Post-dilation endoscopic inspection confirms successful stenosis widening and identifies any immediate complications.

CASE REPORT

Department of Gastroenterology, Virginia Tech Carilion School of Medicine

Patient:

75-year-old male

Presentation:

Nausea, vomiting, and abdominal distension

Indication:

Gastric outlet obstruction confirmed by CT scan

Endoscopic Findings

A ring-like fibroinflammatory stenosis was identified between the first and second portions of the duodenum (Panel A).
The stenosis was approximately 5 mm thick and 8 mm in diameter.
The gastroscope could not pass through the stenosis.

Endoscopic Technique

A guidewire was advanced through the stenosis.
A through-the-scope, controlled radial expansion balloon dilation catheter was advanced over the guidewire (Panel B).
A 13-14-15 mm balloon catheter was positioned such that the first marker was visible. It was then pulled back to ensure approximately half the length of the balloon was across the stenosis (Panels C, D) for homogeneous dilation.
The balloon was inflated with water (Panel E) under direct endoscopic visualization, observing mucosal rips (Panel F).
Post-dilation inspection (Panel G) was performed by advancing the deflated balloon deep into the dilated area.
Mucosal breaks were even and not deep (Panel H).
The endoscope could easily pass through the post-dilation stenosis.

Discussion

Endoscopic balloon dilation is a safe and effective technique for benign duodenal stenoses, particularly when a guidewire is utilized to prevent distal perforation.

Visualizing mucosal rips during dilation provides real-time feedback on the adequacy of dilation. This feedback helps prevent over-dilation.

The use of water for balloon inflation in cases without fluoroscopic guidance offers smoother and easier inflation compared to contrast medium.

A final inspection with the balloon catheter after deflation confirms successful dilation and assesses for complications.

References

Adler DG, Baron TH, Mashimo R, et al. Endoscopic balloon dilation of gastrointestinal stenoses: methodology and future directions. Gastrointest Endosc. 2004;60(1):151-155.
Standards of Practice Committee, ASGE. The role of endoscopy in the management of benign adult esophageal strictures. Gastrointest Endosc. 2021;93(3):525-538.
Kim M, Kim SJ, Lee TH, et al. Endoscopic balloon dilation for benign anastomotic stricture after gastric cancer surgery. BMC Gastroenterol. 2018;18(1):157.

About the author

Klaus Mönkemüller, MD, PhD, FASGE, FJGES, FESGE

Editor-in-Chief, The Practicing Endoscopist

Professor of Medicine, Carilion Memorial Hospital / Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA

Klaus Mönkemüller, MD, PhD, FASGE, FJGES, FESGE, is the editor-in-chief of The Practicing Endoscopist and the founder of EndoCollab. He is Professor of Medicine at Virginia Tech Carilion School of Medicine and a practicing endoscopist at Carilion Memorial Hospital in Roanoke, Virginia.

Dr. Mönkemüller has published extensively on endoscopic techniques and devices, with a particular focus on therapeutic endoscopy, foreign body removal, GI bleeding, and the use of caps and accessories in everyday practice. He lectures internationally and has contributed to multiple GI endoscopy textbooks and atlases.

Save this article as a PDF

Drop your email and we'll open a print-ready version you can save as a PDF — and you'll start getting our weekly GI endoscopy newsletter.

← All articles