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Nakamura J, Hikichi T, Tanaka H, Hashimoto M, Kato T, Yanagita T, Ohira H. Endoscopic membrane resection using a scissors-type knife in a pediatric patient with congenital duodenal membranous stenosis. Endoscopy 2024; 56:E4-E5. [PMID: 38194977 PMCID: PMC10776258 DOI: 10.1055/a-2208-6728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Affiliation(s)
- Jun Nakamura
- Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
- Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takuto Hikichi
- Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Hideaki Tanaka
- Pediatric Surgery, Fukushima Medical University Hospital, Fukushima, Japan
| | - Minami Hashimoto
- Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
- Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tsunetaka Kato
- Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
- Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takumi Yanagita
- Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
- Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiromasa Ohira
- Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
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Marakhouski K, Malyshka E, Nikalayeva K, Valiok L, Pataleta A, Sanfirau K, Svirsky A, Averin V. Balloon dilation of congenital perforated duodenal web in newborns: Evaluation of short and long-term results. World J Gastrointest Endosc 2024; 16:343-349. [PMID: 38946850 PMCID: PMC11212519 DOI: 10.4253/wjge.v16.i6.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/23/2024] [Accepted: 04/29/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Incomplete congenital duodenal obstruction (ICDO) is caused by a congenitally perforated duodenal web (CPDW). Currently, only six cases of balloon dilatation of the PDW in newborns have been described. AIM To present our experience of balloon dilatation of a perforated duodenal membrane in newborns with ICDO. METHODS Five newborns who underwent balloon dilatation of the CPDW along a preinstalled guidewire between 2021 and 2023 were included. Nineteen newborns diagnosed with ICDO who underwent laparotomy were included in the control group. RESULTS In all cases, good anatomical and clinical results were obtained. In three cases, a follow-up study was conducted after 1 year. The average time to start enteral feeding per os was significantly earlier in the study group (4.4 d) than in the laparotomic group (21.2 days; P < 0.0001). The time spent by patients in the intensive care unit and hospital after balloon dilatation was also significantly shorter. We determined the selection criteria for possible and effective CPDW balloon dilatation in newborns as follows: (1) Presence of dynamic radiographic signs of the passage of a radiopaque substance beyond the zone of narrowing or radiographic signs of pneumatisation of the duodenum and small bowel distal to the web; (2) presence of endoscopic signs of CPDW; (3) successful cannulation with a guidewire performed parallel to the endoscope, with holes in the congenital duodenal web; and (4) successful positioning of the balloon performed along a freestanding guidewire on the web. CONCLUSION Strictly following selection criteria for newborns with ICDO caused by CPDW ensures that endoscopic balloon dilatation using a pre-installed guidewire is safe and effective and shows good 1-year follow-up results.
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Affiliation(s)
- Kirill Marakhouski
- Division of Diagnostic, Republican Scientific and Practical Centre of Paediatric Surgery, Minsk 220113, Belarus
| | - Elena Malyshka
- Department of Newborn Surgery, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220013, Belarus
| | - Katsiaryna Nikalayeva
- Department of Pediatric Surgery, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220013, Belarus
| | - Larysa Valiok
- Department of Newborn Surgery, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220013, Belarus
| | - Aleh Pataleta
- Division of Diagnostic, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220013, Belarus
| | - Kiryl Sanfirau
- Division of Diagnostic, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220013, Belarus
| | - Aliaksandr Svirsky
- Department of Pediatric Surgery, Republican Scientific and Practical Center of Pediatric Surgery, Minsk 220013, Belarus
| | - Vasily Averin
- Academic Chair of Pediatric Surgery, Belarusian State Medical University, Minsk 220116, Belarus
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Sun S, Zheng S, Wu J, Tang Z, Shen C, Chen G, Dong K. Clinical application of endoscopic diaphragmotomy and dilation in a congenital duodenal diaphragm. Front Pediatr 2024; 12:1298748. [PMID: 38445081 PMCID: PMC10912644 DOI: 10.3389/fped.2024.1298748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/29/2024] [Indexed: 03/07/2024] Open
Abstract
Background A congenital duodenal diaphragm (CDD) is a rare cause of duodenal obstruction in infants and children. The traditional approach to treatment has been surgical intervention either with excision and duodenoplasty or with bypass through a duodenoduodenostomy, which is invasive and carries the risk of anastomotic leakage. Aims To summarize the key points of differential diagnosis and treatment of a CDD under gastroscopy and to evaluate its efficacy and safety. Methods The clinical data of patients with a duodenal obstruction diagnosed and treated by gastroscopy in our hospital between January 2019 and December 2022 were retrospectively analyzed. The gastroscopic features of the CDD were summarized. The clinical outcomes of patients with CDD treated by gastroscopy were collected and investigated. Results A total of 13 children with a duodenal obstruction underwent a gastroscopic examination and/or treatment, and of these, 10 were diagnosed as having a CDD and 3 were finally diagnosed as having an annular pancreas. A dome-shaped structure during inspiration (9/10) and a guidewire that could be inserted through the opening into the distal lumen (6/10) were the gastroscopic features of the CDD, while the annular pancreas had none of these features. The 10 patients, 4 men and 6 women with the CDD, were treated through endoscopic diaphragmotomy and dilation. The age and weight at operation was 15 days to 7 years (M: 2.25 years) and 2.85-22 kg (M: 13.6 kg), respectively. A total of 11 endoscopic operations were performed in the 10 patients. The time of single operation was 15-55 min (M: 38 min). The patients did not experience complications such as bleeding, pneumoperitoneum, and duodenal papilla injury during the operation. Feeding was started 12-24 h after surgery, and the patients were discharged 2-10 days (M: 7 days) postoperatively. The patients were followed up for 3-36 months (M: 17 months), and none of them had a recurrence of vomiting. However, three showed a recurrence of stenosis in upper gastrointestinal imaging, one of whom underwent a partial diaphragm resection again 2 months after the primary treatment. Conclusions A CDD can be confirmed by endoscopy based on its characteristic features. Endoscopic diaphragmotomy and balloon dilation are safe and effective, which can be a new option for minimally invasive treatment of a CDD.
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Affiliation(s)
- Song Sun
- Surgical Department, Children’s Hospital of Fudan University, Shanghai, China
| | - Shan Zheng
- Surgical Department, Children’s Hospital of Fudan University, Shanghai, China
| | - Jie Wu
- Gastroenterology Department, Children’s Hospital of Fudan University, Shanghai, China
| | - Zifei Tang
- Gastroenterology Department, Children’s Hospital of Fudan University, Shanghai, China
| | - Chun Shen
- Surgical Department, Children’s Hospital of Fudan University, Shanghai, China
| | - Gong Chen
- Surgical Department, Children’s Hospital of Fudan University, Shanghai, China
| | - Kuiran Dong
- Surgical Department, Children’s Hospital of Fudan University, Shanghai, China
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Baran JV, Brown JM, Rivera-Nieves D, Karjoo S, Smithers CJ, Wilsey MJ. Avoiding Surgery: Endoscopic Treatment of Congenital Duodenal Stenosis. JPGN REPORTS 2023; 4:e347. [PMID: 38034463 PMCID: PMC10684216 DOI: 10.1097/pg9.0000000000000347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 05/24/2023] [Indexed: 12/02/2023]
Abstract
Duodenal stenosis is a rare congenital anomaly that is typically treated surgically, although endoscopic incisional therapy (EIT) and balloon dilation are minimally invasive alternatives. We present a case of a 15-month-old male with vomiting and difficulty tolerating solid food due to severe congenital duodenal stenosis. The patient underwent EIT and serial duodenal dilation to a diameter of 20 mm, which resulted in significant symptom improvement. Intralesional corticosteroid injection (ISI) was administered to help prevent the duodenal septum from restricturing. The combination of EIT, balloon dilation, and ISI was successful in treating the patient's congenital duodenal stenosis and avoided the need for surgery. However, further studies are required to confirm the efficacy of this treatment approach in this patient population. This report highlights the potential of this minimally invasive approach as an alternative to surgical intervention in the management of congenital duodenal stenosis.
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Affiliation(s)
- Jessica V. Baran
- From the Office of Medical Education, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL
- Department of Gastroenterology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
| | - Jerry M. Brown
- From the Office of Medical Education, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL
- Department of Gastroenterology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
| | - Desiree Rivera-Nieves
- Department of Gastroenterology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
| | - Sara Karjoo
- Department of Gastroenterology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
| | - C. Jason Smithers
- Department of Surgery, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
| | - Michael J. Wilsey
- Department of Gastroenterology, Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
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5
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Wang X, Lin K, Liu H, Hu Z, Ye G, Sheng Q, Lv Z. Endoscopic Balloon Dilatation-Based Membrane Resection for Membranous Duodenal Stenosis: A Feasibility and Safety Study (With Video). J Pediatr Gastroenterol Nutr 2023; 77:e36-e41. [PMID: 37285839 PMCID: PMC10348657 DOI: 10.1097/mpg.0000000000003848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 05/18/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Surgery is generally considered as the first-line therapy for membranous duodenal stenosis (MDS) in children. However, abdominal surgery leaves permanent scars and may even cause intestinal adhesion. Therefore, an effective, safe, and minimally invasive method is urgently needed. This study aimed to evaluate the safety, efficacy, and feasibility of endoscopic balloon dilatation-based membrane resection (EBD-MR) to treat MDS in children. METHODS We retrospectively reviewed patients with MDS treated with EBD-MR in Shanghai Children's Hospital from May 2016 to August 2021. Primary study outcome was clinical success, defined as weight gain and complete remission of vomiting, without the need for repeat endoscopic or surgical intervention during follow-up. Secondary outcomes included technical success, diameter changes of the membrane opening, and adverse events. RESULTS Nineteen children (9 females, mean age 14.5 ± 11.2 months) received endoscopic treatment for MDS, and clinical success was achieved in 18 of 19 patients (94.7%). No bleeding, perforation, and jaundice occurred. Diameters of the membrane opening increased from 2.97 ± 2.87 mm to 9.78 ± 1.27 mm after the treatment, symptoms of vomiting did not reappear during 10-73 months of follow-up, and body mass index of the children increased from 14.9 ± 2.2 kg/m 2 (pre-operation) to 16.2 ± 3.7 kg/m 2 (6 months after operation). One patient required surgical revision because of existence of a second web; three patients received 2-3 sessions of endoscopic treatment to obtain the final remission. CONCLUSIONS The EBD-MR technique is safe, effective, and feasible for MDS, which provided an excellent alternative to surgical management for the disease in pediatric patients.
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Affiliation(s)
- Xing Wang
- From the Department of Digestive Endoscopy Center, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Kai Lin
- From the Department of Digestive Endoscopy Center, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Haifeng Liu
- From the Department of Digestive Endoscopy Center, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhihong Hu
- From the Department of Digestive Endoscopy Center, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Guogang Ye
- the Department of General Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Qingfeng Sheng
- the Department of General Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhibao Lv
- the Department of General Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Sundin A, Huerta CT, Nguyen J, Brady AC, Hogan AR, Perez EA. Endoscopic Management of a Double Duodenal Web: A Case Report of a Rare Alimentary Anomaly. Clin Med Insights Pediatr 2023; 17:11795565231186895. [PMID: 37529623 PMCID: PMC10387769 DOI: 10.1177/11795565231186895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/22/2023] [Indexed: 08/03/2023] Open
Abstract
Duodenal webs are a rare clinical entity with the presentation of a double duodenal web being exceedingly uncommon. Management of duodenal webs traditionally involves duodenal web excision with duodenoduodenostomy, which is usually performed via a laparoscopic or an open approach. We report the case of a 6-month-old child who presented with progressively worsening bilious emesis with imaging findings concerning for a duodenal web. Endoscopic evaluation was performed that identified 2 webs in the fourth portion of the duodenum. These were managed completely endoscopically with balloon dilation. Although surgery is the mainstay of treatment of duodenal webs, this patient was successfully managed by endoscopic intervention without the need for open or laparoscopic excision, which has not been previously described for double duodenal webs. This work demonstrates the safety and efficacy of endoscopic management for infants with this anomaly.
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Affiliation(s)
| | | | | | | | | | - Eduardo A Perez
- Eduardo A Perez, Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, 1120 NW 14th Street, Suite 450K, Miami, FL 33136, USA.
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Lum Min SA, Imam M, Zrinyi A, Shawyer AC, Keijzer R. Post-discharge follow-up of congenital duodenal obstruction patients: a systematic review. Pediatr Surg Int 2023; 39:239. [PMID: 37490166 DOI: 10.1007/s00383-023-05515-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE Long-term follow-up of congenital duodenal obstruction patients often falls on care providers with little experience of this condition. We performed a systematic review of the long-term outcomes of duodenal obstruction and provide a summary of sequelae care providers should anticipate. METHODS In 2022, after registering with PROSPERA, Medline (Ovid), EMBASE, PSYCHINFO, CNAHL and SCOPUS databases were searched using the title keyword 'intestinal atresia'. Abstracts were filtered for inclusion if they included the duodenum. Papers of filtered abstracts were included if they reported post-discharge outcomes. Methodological Index for Non-Randomized Studies was used to grade the papers. RESULTS Of the 1068 abstracts were screened, 32 papers were reviewed. Eleven studies were included. Thirty additional papers were included after reviewing references, for a total of 41 papers. The average MINORS was 7/16. CONCLUSION There is good evidence that children with congenital duodenal obstruction do well in terms of survival, growth and general well-being. Associated cardiac, musculoskeletal and renal anomalies should be ruled-out. Care providers should be aware of anastomotic dysfunction, blind loop syndrome, bowel obstruction and reflux. Reflux may be asymptomatic. Laparoscopic repair does not change long-term outcomes, and associated Trisomy 21 worsens neurodevelopmental outcomes.
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Affiliation(s)
- Suyin A Lum Min
- Department of Surgery, Division of Pediatric Surgery and Children's Hospital Research Institute of Manitoba, University of Manitoba, AE402-820 Sherbrook Street, Winnipeg, MB, R3A 1S1, Canada
| | - Malaz Imam
- Department of Surgery, Division of Pediatric Surgery and Children's Hospital Research Institute of Manitoba, University of Manitoba, AE402-820 Sherbrook Street, Winnipeg, MB, R3A 1S1, Canada
| | - Anna Zrinyi
- Department of Surgery, Division of Pediatric Surgery and Children's Hospital Research Institute of Manitoba, University of Manitoba, AE402-820 Sherbrook Street, Winnipeg, MB, R3A 1S1, Canada
| | - Anna C Shawyer
- Department of Surgery, Division of Pediatric Surgery and Children's Hospital Research Institute of Manitoba, University of Manitoba, AE402-820 Sherbrook Street, Winnipeg, MB, R3A 1S1, Canada
| | - Richard Keijzer
- Department of Surgery, Division of Pediatric Surgery and Children's Hospital Research Institute of Manitoba, University of Manitoba, AE402-820 Sherbrook Street, Winnipeg, MB, R3A 1S1, Canada.
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Yabe K, Matsuoka A, Nakata C, Hasegawa A, Nakazawa T, Horiuchi A, Kouchi K. Mini-probe endoscopic ultrasound for the diagnosis of congenital esophageal or duodenal stenosis. J Med Ultrason (2001) 2023; 50:177-185. [PMID: 36645628 DOI: 10.1007/s10396-023-01281-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/14/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE The usefulness of endoscopic ultrasound (EUS) in pediatric populations has been recently appreciated; however, published studies on mini-probe EUS in the diagnosis of congenital esophageal stenosis (CES) or congenital duodenal stenosis (CDS) in pre-school patients remain scarce. This study aimed to report the utility of mini-probe EUS for the diagnosis of CES or CDS in pre-school patients based on the etiology. METHODS We retrospectively reviewed the medical records of pediatric patients with CES or CDS who underwent mini-probe EUS through the stenotic segments at our hospital between December 2006 and December 2021. RESULTS Five patients with CES and one with CDS were enrolled. The median age and body weight when EUS was performed were 12.5 months and 8.5 kg, respectively. Hypoechoic lesions were observed on EUS in three patients, which were assessed as cartilage; one patient had no hypoechoic lesion but had a focal thickness of the muscular layer. They were diagnosed with tracheobronchial remnants based on EUS. The full circumferential wall thickness of the esophagus was visualized in one patient with fibromuscular hypertrophy. The histopathological findings confirmed the diagnoses. In the patient with CDS, EUS findings revealed pancreatic parenchyma encircling the stenotic part of the duodenum. The preoperative diagnosis was annular pancreas. The patient underwent duodenoduodenostomy, and intraoperative findings confirmed the diagnosis. CONCLUSION Mini-probe EUS can be recommended as a feasible and safe technique for infants and toddlers. It can effectively diagnose CES or CDS based on etiology and can inform treatment strategies for pre-school patients.
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Affiliation(s)
- Kiyoaki Yabe
- Department of Pediatric Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadasinden, Yachiyo-Shi, Chiba, Japan. .,Digestive Disease Center, Showa Inan General Hospital, Nagano, Japan.
| | - Aki Matsuoka
- Department of Pediatric Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadasinden, Yachiyo-Shi, Chiba, Japan
| | - Chikako Nakata
- Department of Pediatric Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadasinden, Yachiyo-Shi, Chiba, Japan
| | - Atsuko Hasegawa
- Department of Pathology, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| | - Tadao Nakazawa
- Department of Pathology, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| | - Akira Horiuchi
- Digestive Disease Center, Showa Inan General Hospital, Nagano, Japan
| | - Katsunori Kouchi
- Department of Pediatric Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Owadasinden, Yachiyo-Shi, Chiba, Japan
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Kueppers J, Muensterer O. Innovative Endoscopic Management of a Duodenal Web Using Balloon Dilatation and a Gastrojejunal Tube in an Infant with Complex Esophageal Atresia. J Laparoendosc Adv Surg Tech A 2022; 32:1269-1271. [PMID: 36445752 DOI: 10.1089/lap.2022.0240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Congenital partial duodenal obstruction (CPDO) is a rare type of intestinal obstruction, including webs and stenoses. Treatment has usually been operative by laparoscopy or laparotomy. Some have proposed endoscopic treatment due to a higher surgical risk in patients with CPDO. However, restenosis seems to be frequent after simple balloon dilatation. Material and Methods: We report on a patient with CPDO and complex esophageal atresia in whom we used a gastrojejunal tube to keep the lumen open after endoscopic balloon dilatation over a guidewire. Results: Follow-up endoscopy showed no evidence of restenosis. During the third endoscopy, the opening could be dilated to 15 mm without any complications and the gastrojejunal tube was removed. Since then, there were no clinical signs of obstruction, and no further endoscopic intervention was necessary. Discussion and Conclusion: Using a gastrojejunal tube after endoscopic balloon dilatation of a duodenal web may lower the risk of restenosis. This technique should be considered in patients with comorbidities and considerable surgical risk that have a gastrostomy in place.
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Affiliation(s)
- Julia Kueppers
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Oliver Muensterer
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
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Morris G, Kennedy A. Small Bowel Congenital Anomalies. Surg Clin North Am 2022; 102:821-835. [DOI: 10.1016/j.suc.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wang X, Liu H, Ye G, Lv Z, Hu Z. Successful management of membranous duodenal stenosis by endoscopic balloon dilation and membrane resection with an insulated-tip knife. Endoscopy 2022; 54:E256-E258. [PMID: 34102681 DOI: 10.1055/a-1506-2785] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Xing Wang
- Department of Digestive Endoscopy Center, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Haifeng Liu
- Department of Digestive Endoscopy Center, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Guogang Ye
- Department of General Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhibao Lv
- Department of General Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhihong Hu
- Department of Digestive Endoscopy Center, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Li S, Zhao Y, Zhang Y, Liao J, Hua K, Gu Y, Wang D, Tian J, Huang J. Indocyanine Green Localization for Laparoscopic Duodenal Web Excision. Photodiagnosis Photodyn Ther 2022; 38:102842. [DOI: 10.1016/j.pdpdt.2022.102842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/22/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
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13
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Patterson KN, Cruz S, Nwomeh BC, Diefenbach KA. Congenital duodenal obstruction - Advances in diagnosis, surgical management, and associated controversies. Semin Pediatr Surg 2022; 31:151140. [PMID: 35305801 DOI: 10.1016/j.sempedsurg.2022.151140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Congenital duodenal obstruction (CDO) occurs due to intrinsic and extrinsic mechanisms but is most often caused by intrinsic duodenal atresia and stenosis. This review will summarize the history, epidemiology, and etiologies associated with the most common causes of CDO. The clinical presentation, complex diagnostic considerations, and current surgical repair options for duodenal atresia and stenosis will also be discussed. Finally, both historical and recent controversies which continue to affect the surgical decision-making in the management of these patients will be highlighted.
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Affiliation(s)
- Kelli N Patterson
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205
| | - Stephanie Cruz
- Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205
| | - Benedict C Nwomeh
- Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205
| | - Karen A Diefenbach
- Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205.
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14
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Sega AG, Meckmongkol T, Westmoreland T. Delayed Presentation of Duodenal Atresia in a Male With Trisomy 21. Cureus 2022; 14:e21700. [PMID: 35237490 PMCID: PMC8882360 DOI: 10.7759/cureus.21700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 11/05/2022] Open
Abstract
The duodenum is the secondmost common site of congenital intestinal obstruction. There are three types of congenital duodenal atresia according to the severity of obstruction. Duodenal atresia is thought to develop due to the failure of recanalization of the gut lumen during embryonic development. This congenital abnormality usually presents in utero or shortly after birth with signs of intestinal obstruction. However, rare cases can present later in life. In this case report, we will discuss a two-year-old male with trisomy 21 who presented with intractable vomiting and failure-to-thrive. He did not have the classic clinical or diagnostic signs of duodenal atresia, but on exploratory laparotomy, he was found to have severe duodenal stenosis. Diamond-shaped duodenoduodenostomy was performed to bypass the stenosed intestine. The patient recovered well from surgery and was able to tolerate a soft mechanical diet without vomiting one week postoperatively. This case exhibits a particularly delayed and atypical presentation of duodenal stenosis. Yet, it is imperative to recognize this presentation from an educational and clinical standpoint for surgical intervention.
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Tang YP, Wei XX, Fu XL, Xue N, Xu JJ. Successful treatment with endoscopic radial incision for congenital duodenal membranous stenosis in three children. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.102043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Diagnosis of Annular Pancreas With Congenital Duodenal Stenosis by Endoscopic Ultrasound in a Paediatric Patient. J Pediatr Gastroenterol Nutr 2021; 73:e79. [PMID: 34091546 DOI: 10.1097/mpg.0000000000003192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Liang C, Tan Y, Lu J, Le M, Liu D. Endoscopic incision for treatment of benign gastrointestinal strictures. Expert Rev Gastroenterol Hepatol 2020; 14:445-452. [PMID: 32380885 DOI: 10.1080/17474124.2020.1766966] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Benign gastrointestinal strictures are common, and can be congenital or acquired (anastomotic, corrosive, induced by Crohn's disease or endoscopic treatments, etc.). Patients usually present with stricture-related symptoms such as vomiting, dysphagia, dyschezia, abdominal pain, which impair their quality of life. Endoscopic balloon dilation (EBD) is the first-line treatment for most of the benign strictures; however, long-term efficacy is suboptimal, and the recurrence rate can be up to 38%. Endoscopic incision (EI) was firstly reported for treatment of congenital membranous stricture, and then applied to other benign gastrointestinal strictures. AREA COVERED In the present review, we provided a comprehensive review of EI for the treatment of benign gastrointestinal strictures, mainly focus on the technical details, indication, safety, and efficacy of EI. The present review is expected to provide tips for operators who are going to perform EI. EXPERT OPINION EI can serve as an alternative method for treatment of gastrointestinal strictures, the best indications are congenital membranous stricture and short-segmental (<1 cm) anastomotic strictures refractory to EBD. EI may also be attempted for strictures induced by other reasons. Combination with other endoscopic methods such as EBD, local steroid injection, stent placement, may improve the efficacy of EI.
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Affiliation(s)
- Chengbai Liang
- Department of Gastroenterology, The Second Xiangya Hospital , Changsha, Hunan, China.,Research Center of Digestive Disease, Central South University , Changsha, Hunan, China
| | - Yuyong Tan
- Department of Gastroenterology, The Second Xiangya Hospital , Changsha, Hunan, China.,Research Center of Digestive Disease, Central South University , Changsha, Hunan, China
| | - Jiaxi Lu
- Department of Gastroenterology, The Second Xiangya Hospital , Changsha, Hunan, China.,Research Center of Digestive Disease, Central South University , Changsha, Hunan, China
| | - Meixian Le
- Department of Gastroenterology, The Second Xiangya Hospital , Changsha, Hunan, China.,Research Center of Digestive Disease, Central South University , Changsha, Hunan, China
| | - Deliang Liu
- Department of Gastroenterology, The Second Xiangya Hospital , Changsha, Hunan, China.,Research Center of Digestive Disease, Central South University , Changsha, Hunan, China
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Goring J, Isoldi S, Sharma S, Torroni F, Marven S, De Angelis P, Thomson M. Natural orifice endoluminal technique (NOEL) for the management of congenital duodenal membranes. J Pediatr Surg 2020; 55:282-285. [PMID: 31839373 DOI: 10.1016/j.jpedsurg.2019.10.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/26/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Congenital Partial Duodenal Obstruction (CPDO) caused by membranes/webs/diaphragms has traditionally been managed by open or laparoscopic duodenoduodenostomy or duodenojejunostomy. We report a two center case series where Natural Orifice Endoluminal technique (NOEL) was used to treat children with CPDO. METHODS A retrospective case series was evaluated. Data collected included the duration of procedure, postoperative complications, length of stay, and need for further procedures. RESULTS Fifteen patients were treated over a 10 year period by NOEL technique for late presenting CPDO. Four patients were managed at Sheffield Children's Hospital (Center A, UK), and 11 patients were managed in Bambino Gesù Hospital of Rome (Center B, Italy). 20% of the patients had more than one duodenal obstructing membrane. Both balloon dilatation and membrane incision techniques were used. Median follow up was 23 months (range 2-69) in Center A and 18 months (range 7-58) in Center B. 60% of patients were successfully treated with 1 NOEL procedure. 20% required 2 or 3 procedures to achieve long term luminal patency. 20% required surgery after NOEL failed to treat the partial obstruction definitively. One patient in Center A required radiological drainage of a retroperitoneal collection following perforation during NOEL. CONCLUSION NOEL technique is feasible and effective in selected children with CPDO. Both balloon dilatation and incision techniques can be used. Care must be taken to rule out a second distal obstruction. We would recommend that all infants and children with CPDO owing to a fenestrated membrane should be considered for NOEL. TYPE OF STUDY Case series. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | - Sara Isoldi
- Bambino Gesù Children's Hospital, Rome, Italy
| | - Shishu Sharma
- Sheffield Children's Hospital, Sheffield, United Kingdom
| | | | - Sean Marven
- Sheffield Children's Hospital, Sheffield, United Kingdom
| | | | - Mike Thomson
- Sheffield Children's Hospital, Sheffield, United Kingdom.
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19
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Endoscopic Management of Duodenal Web. J Pediatr Gastroenterol Nutr 2019; 69:e117. [PMID: 30628986 DOI: 10.1097/mpg.0000000000002250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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20
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Endoscopic Treatment of Duodenal Web in Association With Annular Pancreas in an Infant. J Pediatr Gastroenterol Nutr 2018; 67:e83-e85. [PMID: 29570140 DOI: 10.1097/mpg.0000000000001977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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21
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Shakir AK, Ramji F, El Halabi I. Penny for Your Thoughts; A Coin in the Stomach: Why Did It Get Stuck? Hosp Pediatr 2017; 7:294-296. [PMID: 28400420 DOI: 10.1542/hpeds.2016-0187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Asiya K Shakir
- Section of Pediatric Gastroenterology, Department of Pediatrics, and
| | - Faridali Ramji
- Section of Pediatric Imaging, Department of Radiological Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Issam El Halabi
- Section of Pediatric Gastroenterology, Department of Pediatrics, and
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22
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Transumbilical Surgery for Duodenal Stenosis in a Child with Situs Inversus: The First Report. Case Rep Pediatr 2017; 2017:2074387. [PMID: 28386502 PMCID: PMC5366199 DOI: 10.1155/2017/2074387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 12/22/2016] [Indexed: 11/29/2022] Open
Abstract
Background. Situs inversus is a rare congenital anomaly with a reported incidence of only 1 in 5,000 to 10,000 live births. Congenital duodenal stenosis complicated with situs inversus is an even rarer entity. Case Presentation. A 1-year-old girl with situs inversus who had undergone a hemi-Fontan procedure against a single ventricle in our hospital was referred to our department for vomiting and failure to thrive. An upper gastrointestinal contrast study and endoscopy revealed duodenal stenosis. A transumbilical radical operation as a minimally invasive surgery was successfully performed. After the surgery, she stopped vomiting, and the postoperative course was uneventful with good cosmetic results. Conclusions. To our knowledge, this is the first report of transumbilical surgery for congenital duodenal stenosis with situs inversus as minimally invasive surgery. Transumbilical surgery to situs inversus patient can be performed safely and lead to good cosmetic outcome.
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Abstract
The small intestine is a complex organ system that is vital to the life of the individual. There are a number of congenital anomalies that occur and present most commonly in infancy; however, some may not present until adulthood. Most congenital anomalies of the small intestine will present with obstructive symptoms while some may present with vomiting, abdominal pain, and/or gastrointestinal bleeding. Various radiologic procedures can aid in the diagnosis of these lesions that vary depending on the particular anomaly. Definitive therapy for these congenial anomalies is surgical, and in some cases, surgery needs to be performed urgently. The overall prognosis of congenital anomalies of the small intestine is very good and has improved with improved medical management and the advent of newer surgical modalities. The congenital anomalies of the small intestine reviewed in this article include malrotation, Meckel's diverticulum, duodenal web, duodenal atresia, jejunoileal atresia, and duplications.
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Affiliation(s)
- Grant Morris
- Department of Pediatrics, Geisinger Clinic, 100 N. Academy Avenue, Danville, PA, 17822, USA
| | - Alfred Kennedy
- Department of Pediatric Surgery, Geisinger Clinic, 100 N. Academy Avenue, Danville, PA, 17822, USA
| | - William Cochran
- Department of Pediatric Gastroenterology, Geisinger Clinic, 100 N. Academy Avenue, Danville, PA, 17822, USA.
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Poddar U, Jain V, Yachha SK, Srivastava A. Congenital duodenal web: successful management with endoscopic dilatation. Endosc Int Open 2016; 4:E238-41. [PMID: 27004237 PMCID: PMC4798844 DOI: 10.1055/s-0041-110955] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 12/07/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Congenital duodenal web (CDW) is an uncommon cause of duodenal obstruction and endoscopic balloon dilatation has been reported in just eight pediatric cases to date. Here we are reporting three cases of CDW managed successfully with balloon dilatation. CASES AND METHODS In 2014 we diagnosed three cases of CDW on the basis of typical radiological and endoscopic findings. Endoscopic balloon dilatation was done under conscious sedation with a through-the-scope controlled radial expansion (CRE) balloon. RESULTS All three children presented late (median age 8 [range 2 - 9] years) with bilious vomiting, upper abdominal distension, and failure to thrive. One of them had associated Down syndrome and another had horseshoe kidney. In all cases, CDW was observed in the second part of the duodenum beyond the ampulla, causing partial duodenal obstruction. After repeated endoscopic dilatation (2 - 4 sessions), all three patients became asymptomatic. None of the patients experienced complications after balloon dilatation. CONCLUSIONS Duodenal diaphragm should be suspected in patients with abdominal distension with bilious vomiting, even in relatively older children. Endoscopic balloon dilatation is a simple and effective method of treating this condition.
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Affiliation(s)
- Ujjal Poddar
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India,Corresponding author: Ujjal Poddar, MD, DNB, DM Department of Pediatric GastroenterologySGPGIMS, Lucknow-226014India+91-522-249-4418+91-522-266-8017
| | - Vikas Jain
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Surender Kumar Yachha
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Anshu Srivastava
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Wood LSY, Kastenberg Z, Sinclair T, Chao S, Wall JK. Endoscopic Division of Duodenal Web Causing Near Obstruction in 2-Year-Old with Trisomy 21. J Laparoendosc Adv Surg Tech A 2016; 26:413-7. [PMID: 26913816 DOI: 10.1089/lap.2015.0462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Surgical intervention for duodenal atresia most commonly entails duodenoduodenostomy in the neonatal period. Occasionally, type I duodenal atresia with incomplete obstruction may go undiagnosed until later in life. Endoscopic approach to dividing intestinal webs has been reported as successful in patients as young as 7 days of age, and can be a useful modality particularly in patients with comorbidities who may not tolerate open or laparoscopic surgery. METHODS A 2-year-old female with a history of trisomy 21 and tetralogy of Fallot underwent laparoscopic and endoscopic exploration of intestinal obstruction as seen on upper gastrointestinal series for symptoms of recurrent emesis and weight loss. After laparoscopy confirmed a duodenal web as the cause of intestinal obstruction, endoscopic division of the membrane was carried out with a triangle tip electrocautery knife and 15 mm radially dilating balloon. RESULTS The patient tolerated the procedure well, and also tolerated full age-appropriate diet by time of discharge on postoperative day 2. She remains asymptomatic as of 6 months postoperatively. CONCLUSIONS This report describes a successful endoscopic approach for definitive treatment of a duodenal web in a 2-year-old girl with trisomy 21, and laparoscopy confirmed no intraabdominal obstructive process or complication from endoscopy. Endoscopy enables minimal recovery time and suggests an improved method of duodenal web division over pure surgical intervention.
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Affiliation(s)
- Lauren S Y Wood
- Department of Pediatric Surgery, Lucile Packard Children's Hospital, Stanford University , Stanford, California
| | - Zachary Kastenberg
- Department of Pediatric Surgery, Lucile Packard Children's Hospital, Stanford University , Stanford, California
| | - Tiffany Sinclair
- Department of Pediatric Surgery, Lucile Packard Children's Hospital, Stanford University , Stanford, California
| | - Stephanie Chao
- Department of Pediatric Surgery, Lucile Packard Children's Hospital, Stanford University , Stanford, California
| | - James K Wall
- Department of Pediatric Surgery, Lucile Packard Children's Hospital, Stanford University , Stanford, California
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