Gastrointestinal
Intervention
Dilatation
of benign or malignant oesophageal strictures can be performed with either
endoscopic or fluoroscopic guidance. The choice depends on local expertise but
screening during dilatation is advisable to reduce the risk of oesophageal
perforation. Balloon dilatation is achieved by the introduction of a balloon
over a guidewire under fluoroscopic guidance. Balloon dilatation has the
advantage of providing a controlled radial dilating force without the
In
patients with malignant oesophageal disease, considered incurable by surgical
intervention, oesophageal stent placement provides good palliation. The use of
rigid plastic stents (Celestin or Atkinson tubes) has been gradually superseded
by self-expanding metal stents (Fig. 2.39). Some of these are covered with
plastic, minimising tumour ingrowth and sealing any associated perforation or
fistula. Placement rapidly relieves symptoms, allowing the patient to return
home to a relatively normal diet. These techniques are being expanded to
strictures elsewhere in the gastrointestinal tract. Duodenal and colonic
strictures have been satisfactorily
Percutaneous
gastrostomy placement provides a more comfortable alternative to long-term
nasogastric feeding in patients who are unable to maintain nutrition with oral
intake. This is usually as a result of upper aerodigestive tract malignancy or
an inability to swallow as a result of a previous cerebrovascular accident.
Percutaneous placement of gastrostomy feeding tubes can be achieved using
either endoscopy or fluoroscopy. The choice again largely depends on local