Hydrostatic balloon dilatation for stomal stenosis after gastric partitioning

Hydrostatic balloon dilatation has been used successfully to treat several patients with stomal stenosis occurring as a late complication of gastroplasty. The technique of hydrostatic balloon dilatation practiced in this institution is reviewed in detail. This technique appears to offer several advantages over previous techniques: 1) the procedure can be accomplished with intravenous sedation eliminating the need for general anesthesia; 2) trauma to the gastric channel is minimized because no attempt is made to manipulate the endoscope through the stoma into the distal stomach; 3) radiopaque markers on the polyethylene balloon catheter permit easy and accurate positioning of the balloon within the gastric channel; 4) the low compliance characteristics of the polyethylene balloon used permit inflation to a predetermined outer diameter with minimum risk of balloon deformity or overdistention and rupture; and 5) the procedure is easily standardized and can therefore be expected to yield reproducible results. Late stomal stenosis after gastric partitioning may respond to conservative therapy including nutritional support and dietary counselling. Hydrostatic balloon dilatation should be considered as the preferred method of stomal dilatation in patients refractory to alternative forms of management.