Through-the-Scope Balloon Dilation for Endoscopic Ultrasound Staging of Stenosing Esophageal Cancer

Abstract

Dilation of malignant esophageal strictures often is required to complete staging by endoscopic ultrasound (EUS). This study was designed to determine the successful dilation rate (ability to complete staging) and complication rate of through-the-scope (TTS) balloon dilation for malignant esophageal strictures during EUS. We retrospectively reviewed EUS reports for all cases of primary esophageal cancer staged at five centers between January 2002 and October 2004. All dilations were performed with TTS balloons. Among 272 endoscopic ultrasounds, dilation was required in 77 (28%) and was successful in 73 cases (95%). There was one esophageal perforation after dilation (1.3%; 95% confidence interval (CI), 0.2-7) and one esophageal perforation after EUS without dilation (0.5%; 95% CI, 0.1-2.8; P = 0.48 by two-sided Fisher exact test). There were no other major complications. TTS balloon dilation is highly successful in permitting complete staging of obstructing tumors. The rate of complications after dilation with a TTS balloon dilator is low and similar to the baseline rate of EUS in this setting.

Transgastric endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) in patients with esophageal narrowing using the ultrasonic bronchovideoscope

“…An important limitation of EUS is esophageal obstruction, and EBUS represents an important tool to address this problem. Tumor staging and evaluation of the celiac axis is potentially limited in nearly one‐third of patients with esophageal cancer because of strictures 1 . Early studies reported high complication rates when aggressive dilatation was used to facilitate echoendoscope passage 2 .…”

“…Tumor staging and evaluation of the celiac axis is potentially limited in nearly one-third of patients with esophageal cancer because of strictures. 1 Early studies reported high complication rates when aggressive dilatation was used to facilitate echoendoscope passage. 2 More cautious dilatation approaches and more facile instruments has improved our capability, though this continues to be a challenging problem for the endosonographer with a low yet significant perforation rate.…”

“…2 More cautious dilatation approaches and more facile instruments has improved our capability, though this continues to be a challenging problem for the endosonographer with a low yet significant perforation rate. 1 A novel approach is to use scopes with a smaller diameter, which can be easily passed beyond narrowed regions. One alternative is the 7.5 MHz Slim Probe (Olympus/KeyMed, Southend-on-Sea, UK), which has a diameter of 7.9 mm.…”

Dilation of Malignant Strictures in Endoscopic Ultrasound Staging of Esophageal Cancer and Metastatic Spread of Disease

“…More recent studies have refuted this and confirmed that dilating with smaller diameter Savary or through-the-scope dilators, one can safely dilate malignant esophageal strictures in order to complete EUS staging [2–4, 11]. …”

EUS Staging of Luminal Cancers in the Upper GI Tract

“…Dilation may be performed with either a Savary dilator over the wire, or with a through-the-scope (TTS) controlled radial expansion (CRE) dilation balloon. A higher rate of esophageal perforation has been reported with dilation of malignant esophageal strictures, but it is generally regarded as safe [11,12]. In our practice, if we experience resistance due to a malignant stricture precluding passage of a standard EGD scope or echoendoscope, we dilate with a TTS CRE balloon up to 14-16 mm so as to then allow for a complete and thorough staging EUS exam.…”