Balloon dilatations is the preferred method of dilatation for most gastrointestinal strictures, because of its efficacy and relative safety. Radiologically guided balloon dilatation was successful in 20 of 24 patients referred for dilatation with a variety of tight gastrointestinal strictures with diameters of 0.5 cm or less. Attempts at endoscopic or bougie dilatation had either failed or were felt unlikely to be successful. A satisfactory result was obtained in all cases in which dilatation was performed. There were no serious complications. Radiologically guided balloon dilatation is both safe and effective for the treatment of very tight or obstructing gastrointestinal strictures.