• Strictures more than 5 cms in length should not be balloon dilated.
• Dilate only fibrotic strictures without ulcer.
• Dilate only if symptomatic.
• Malignant stricture- never dilate

Remember:

• One or more session may be needed. Alternatively, the stricture can be dilated once and if symptoms recur- they can be dilated again.
• The technical success rate, defined as achieving an endoscopically passable residual stricture, is between 70% and 90 %, independent of the balloon’s diameter.
• Complications such as haemorrhages are rare, while perforations are reported mostly in studies in which 25 mm balloons are used.
• It is difficult to define the relapse risk after endoscopic balloon dilatation, as the published studies are heterogenous. In a recent long-term study, stricture relapse rate was 46% after a mean of 32 months. (Stienecker K. Long-term results of endoscopic balloon dilatation of lower gastrointestinal tract strictures in Crohn’s disease: a prospective study. World J Gastroenterol.2009 Jun 7;15(21):2623-7)

Size of balloon
If the stenosis  is > 5mm in diameter- use 18-20 mm balloon
If the stenosis  is < 5mm in diameter- use 15 mm balloon
Pinhole stenosis- 12 mm balloon

Colorectal stent
Indications

• Palliative decompression of advanced disease
• Preoperative decompression- stent insertion avoids an emergency surgery with its benefit on morbidity and mortality

Types of Stent

• Through the scope stents- inserted under direct vision
• Inserted over a guidewire under fluoroscopic guidance

Complications
The major complications are stent migration (11 percent), perforation (4.5 percent), and reobstruction (12 percent).