1
|
Pirkle JRA, Deutsch D. Successful Treatment of Recurrent Pyloric Stenosis Using Balloon Dilation. JPGN REPORTS 2023; 4:e364. [PMID: 38045639 PMCID: PMC10688777 DOI: 10.1097/pg9.0000000000000364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/26/2023] [Indexed: 12/05/2023]
Abstract
Infantile hypertrophic pyloric stenosis is a common surgical disease in infants, with an incidence of 2 to 5 cases per 1000 live births. It often presents with nonbilious projectile vomiting after feeding and a mid-epigastric mass in infants between the third and eighth weeks of life. Ramstedt pyloromyotomy remains the gold standard of treatment. Postoperative emesis is common; however, further evaluation for incomplete pyloromyotomy and recurrent pyloric stenosis should be conducted with prolonged, or new-onset postoperative emesis. While repeat pyloromyotomy is the standard of care for infants presenting with incomplete pyloric stenosis, treatment for the rare development of recurrent pyloric stenosis is not clearly outlined. Here, we report a successful balloon dilation procedure in an 8-week-old female with recurrent pyloric stenosis three and a half weeks after the initial laparoscopic pyloromyotomy.
Collapse
Affiliation(s)
- Jesseca R. A. Pirkle
- From the Department of Pediatric Gastroenterology, College of Medicine, University of Illinois, Rockford, IL
| | - David Deutsch
- From the Department of Pediatric Gastroenterology, College of Medicine, University of Illinois, Rockford, IL
- Department of Pediatric Gastroenterology, MercyHealth Hospital, Rockford, IL
| |
Collapse
|
2
|
Peña-Vélez R, Roldán-Montijo M, Imbett-Yepez S, Ramírez-Mayans J, Loredo-Mayer A, Montijo-Barrios E. Endoscopic Balloon Dilation of Gastric Stenosis secondary to Polyarteritis Nodosa and Arterial Thrombosis in an Adolescent. JPGN REPORTS 2022; 3:e198. [PMID: 37168903 PMCID: PMC10158308 DOI: 10.1097/pg9.0000000000000198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 01/13/2022] [Indexed: 05/13/2023]
Abstract
A 13-year-old female with polyarteritis nodosa underwent a partial gastrectomy for ischemic necrosis and gastric perforation following left gastric artery thrombosis. She later presented with vomiting, early satiety, weight loss, and severe malnutrition, when she was diagnosed with an occlusive gastric stricture. She successfully underwent repeated therapeutic endoscopic balloon dilations until the endpoint of 15-18 mm lumen was achieved without any complications, and her symptoms resolved.
Collapse
Affiliation(s)
- Rubén Peña-Vélez
- From the Department of Pediatric Gastroenterology and Nutrition, Instituto Nacional de Pediatría. Mexico City, Mexico
- School of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Mariana Roldán-Montijo
- From the Department of Pediatric Gastroenterology and Nutrition, Instituto Nacional de Pediatría. Mexico City, Mexico
- School of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Sharon Imbett-Yepez
- From the Department of Pediatric Gastroenterology and Nutrition, Instituto Nacional de Pediatría. Mexico City, Mexico
- School of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Jaime Ramírez-Mayans
- From the Department of Pediatric Gastroenterology and Nutrition, Instituto Nacional de Pediatría. Mexico City, Mexico
- School of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Alejandro Loredo-Mayer
- From the Department of Pediatric Gastroenterology and Nutrition, Instituto Nacional de Pediatría. Mexico City, Mexico
| | - Ericka Montijo-Barrios
- From the Department of Pediatric Gastroenterology and Nutrition, Instituto Nacional de Pediatría. Mexico City, Mexico
| |
Collapse
|
3
|
Comparison of Symptom Control in Pediatric Gastroparesis Using Endoscopic Pyloric Botulinum Toxin Injection and Dilatation. J Pediatr Gastroenterol Nutr 2021; 73:314-318. [PMID: 34091544 DOI: 10.1097/mpg.0000000000003195] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The objective of this study was to assess the tolerance and efficacy of endoscopic intrapyloric botulinum toxin injection compared with pyloric dilatation in children with gastroparesis. METHODS This was a retrospective descriptive multicentre study that included pediatric patients treated between 2010 and 2018 at 4 tertiary hospitals. RESULTS Data were collected for 24 patients. The median age at diagnosis was 2.5 years (range 0.5-4.7). A total of 46 endoscopic procedures were performed. The endoscopic procedure was multiple in 63% of patients. Among the interventions, 76% were successful and 15% were unsuccessful. The recurrence rate was 57% and the median time to recurrence was 3.7 months (0.1-73). The efficacy did not differ significantly between the 2 methods at the first intervention and as a second-line treatment. The recurrence rate also did not differ significantly between the 2 methods. No complications were reported. The median follow-up was 19.8 months (1.7-61.7). CONCLUSIONS In this retrospective multicentre study, endoscopic management of gastroparesis by balloon dilatation or botulinum toxin was safe in children and seemed to be partially efficient within the first months. Symptoms recurred frequently and required repetition of the interventions.
Collapse
|
4
|
Kirakosyan EV, Lokhmatov MM, Budkina TN, Tupylenko AV, Oldakovsky VI, Dyakonova EY. [Staged endoscopic balloon dilatation for cicatricial pyloric stenosis in children]. Khirurgiia (Mosk) 2019:85-90. [PMID: 31464281 DOI: 10.17116/hirurgia201908185] [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: 01/10/2023]
Abstract
Secondary pyloric stenosis quickly leads to homeostatic and nutritional disorders that determines the importance of early diagnosis and surgical treatment. In two clinical cases, we have shown that staged endoscopic balloon dilatation of the pylorus is devoid of the most of the known problems and shortcomings of conventional surgery and makes it possible to restore effectively gastrointestinal passage and to improve child's quality of life. This procedure has a high diagnostic and curative value and is followed by positive dynamics of condition of the child with pyloric stenosis.
Collapse
Affiliation(s)
- E V Kirakosyan
- Sechenov First Moscow State Medical University of Ministry of Health of the Russia, Moscow, Russia
| | - M M Lokhmatov
- Sechenov First Moscow State Medical University of Ministry of Health of the Russia, Moscow, Russia; National Medical Research Center for Children's Health of Ministry of Health of the Russian Federation, Moscow, Russia
| | - T N Budkina
- National Medical Research Center for Children's Health of Ministry of Health of the Russian Federation, Moscow, Russia
| | - A V Tupylenko
- National Medical Research Center for Children's Health of Ministry of Health of the Russian Federation, Moscow, Russia
| | - V I Oldakovsky
- National Medical Research Center for Children's Health of Ministry of Health of the Russian Federation, Moscow, Russia
| | - E Yu Dyakonova
- National Medical Research Center for Children's Health of Ministry of Health of the Russian Federation, Moscow, Russia
| |
Collapse
|
5
|
Yokoyama S, Uyama S, Iwagami H, Yamashita Y. Successful combination of endoscopic pyloromyotomy and balloon dilatation for hypertrophic pyloric stenosis in an older child: A novel procedure. Surg Case Rep 2016; 2:145. [PMID: 27915443 PMCID: PMC5136377 DOI: 10.1186/s40792-016-0274-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/01/2016] [Indexed: 01/30/2023] Open
Abstract
Background Hypertrophic pyloric stenosis (HPS) is a rare cause of gastric outlet obstruction beyond infancy. Ramstedt pyloromyotomy remains the gold standard treatment for HPS. This type of HPS can be managed successfully with pyloromyotomy under laparoscopic or open procedures. Endoscopic pyloric balloon dilation (EPBD) has not been recommended in the treatment of HPS, and there are only a small number of reported cases who had had successful endoscopic pyloromyotomy (EP) for HPS only in infants. Case presentation The patient was suspected of having HPS when the patient was 1 year old after infancy. However, his parents thought that the vomiting and poor sucking were caused by Down syndrome-associated muscular hypotonia. Since then, no additional tests have been performed at their request. At 6 years of age, he was readmitted to our department because of persistent vomiting and failure to thrive, and HPS was diagnosed again. However, it was unknown whether the HPS had been persisting since infancy or was acquired. The first EPBD was slightly effective but did not remain effective for a long time. When the second EPBD was performed in combination with EP, the amount and frequency of vomiting were reduced dramatically. Conclusions The combination of EP and EPBD procedure may represent a safe, effective, and minimally invasive option for selected HPS patients in whom laparotomy would pose a significant risk or who do not respond to conventional medical treatment. To our knowledge, this is the first report to describe combination treatment with EP and EPBD in an older child with HPS.
Collapse
Affiliation(s)
- Satoshi Yokoyama
- Department of Pediatric surgery, Japanese Red Cross Society, Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan.
| | - Shiro Uyama
- Department of Pediatric surgery, Japanese Red Cross Society, Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan
| | - Hiroyoshi Iwagami
- Department of Gastroenterology and Hepatology, Japanese Red Cross Society, Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan
| | - Yukitaka Yamashita
- Department of Gastroenterology and Hepatology, Japanese Red Cross Society, Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, 640-8558, Japan
| |
Collapse
|
6
|
Chao HC. Update on endoscopic management of gastric outlet obstruction in children. World J Gastrointest Endosc 2016; 8:635-645. [PMID: 27803770 PMCID: PMC5067470 DOI: 10.4253/wjge.v8.i18.635] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 06/18/2016] [Accepted: 08/08/2016] [Indexed: 02/06/2023] Open
Abstract
Endoscopic balloon dilatation (EBD) and surgical intervention are two most common and effective treatments for gastric outlet obstruction. Correction of gastric outlet obstruction without the need for surgery is an issue that has been tried to be resolved in these decades; this management has developed with EBD, advanced treatments like local steroid injection, electrocauterization, and stent have been added recently. The most common causes of pediatric gastric outlet obstruction are idiopathic hypertrophic pyloric stenosis, peptic ulcer disease followed by the ingestion of caustic substances, stenosis secondary to surgical anastomosis; antral web, duplication cyst, ectopic pancreas, and other rare conditions. A complete clinical, radiological and endoscopic evaluation of the patient is required to make the diagnosis, with complimentary histopathologic studies. EBD are used in exceptional cases, some with advantages over surgical intervention depending on each patient in particular and on the characteristics and etiology of the gastric outlet obstruction. Local steroid injection and electrocauterization can augment the effect of EBD. The future of endoscopic treatment seems to be aimed at the use of endoscopic electrocauterization and balloon dilatations.
Collapse
|
7
|
Temiz A, Oguzkurt P, Ezer SS, Ince E, Gezer HO, Hicsonmez A. Management of pyloric stricture in children: endoscopic balloon dilatation and surgery. Surg Endosc 2012; 26:1903-8. [PMID: 22234589 DOI: 10.1007/s00464-011-2124-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 12/05/2011] [Indexed: 12/17/2022]
Abstract
BACKGROUND Surgical correction is the most preferred treatment modality in pyloric stricture (PS). Recently a few studies reported the experience of balloon dilation in children with PS. This study was designed to present our experiences of the management of the patients with PS with balloon dilation and corrective surgery. METHODS The records of 14 patients who were treated with the diagnosis of PS between August 2003 and August 2011 were reviewed retrospectively. RESULTS There were nine boys and five girls (mean age, 3.4 ± 1.7 years). The history of caustic ingestion was detected in eight patients; six of them were admitted on the day of ingestion. Two patients were admitted with nonbilious vomiting more than 2 weeks after ingestion. Four patients did not have a remarkable medical history, including caustic ingestion. They admitted with the complaint of nonbilious vomiting. PS was detected during endoscopy in two patients who had a diagnosis of peptic ulcer disease. PS was shown by barium meal study in all patients. Endoscopy was performed in all patients. Endoscopic balloon dilation was tried in 12 patients. Overall eight patients required surgical procedures for PS. The complaints were resolved by endoscopic balloon dilation of pylorus in the remaining six patients. CONCLUSIONS Although endoscopic balloon dilatation for benign PS in adults is a generally accepted method of treatment, there is less experience with endoscopic balloon dilatation for PS in children. PS due to benign disorders can be effectively and successfully treated through endoscopic balloon dilatation in suitable patients. In patients with successful pyloric balloon dilatation, surgery can be avoided.
Collapse
Affiliation(s)
- Abdulkerim Temiz
- Department of Pediatric Surgery, Baskent University Faculty of Medicine, Ankara, Turkey.
| | | | | | | | | | | |
Collapse
|
8
|
Karnsakul W, Cannon ML, Gillespie S, Vaughan R. Idiopathic non-hypertrophic pyloric stenosis in an infant successfully treated via endoscopic approach. World J Gastrointest Endosc 2010; 2:413-6. [PMID: 21191516 PMCID: PMC3010473 DOI: 10.4253/wjge.v2.i12.413] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 09/27/2010] [Accepted: 10/04/2010] [Indexed: 02/05/2023] Open
Abstract
Non-peptic, non-hypertrophic pyloric stenosis has rarely been reported in pediatric literature. Endoscopic pyloric balloon dilation has been shown to be a safe procedure in treating gastric outlet obstruction in older children and adults. Partial gastric outlet obstruction (GOO) was diagnosed in an infant by history and confirmed by an upper gastrointestinal series (UGI). Abdominal ultrasonography and computed tomography scan excluded idiopathic hypertrophic pyloric stenosis, abdominal tumors, gastrointestinal and hepato-biliary-pancreatic anomalies. Endoscopic findings showed a pinhole-sized pylorus and did not indicate peptic ulcer disease, Helicobacter pylori infection, antral web, or evidence of allergic and inflammatory bowel diseases. Three sessions of a step-wise endoscopic pyloric balloon dilation were conducted under general anesthesia and a fluoroscopy at two week intervals using catheter balloons (Boston Scientific Microvasive®, MA, USA) of increasing diameters. Repeat UGI after the first session revealed normal gastrointestinal transit and no intestinal obstruction. The patient tolerated solid food without any gastrointestinal symptoms since the first session. The endoscope was able to be passed through the pylorus after the last session. Although the etiology of GOO in this infant is unclear (proposed mechanisms are herein discussed), endoscopic pyloric balloon dilation was a safe procedure for treating this young infant with non-peptic, non-hypertrophic pyloric stenosis and should be considered as an initial approach before pyloroplasty in such presentations.
Collapse
Affiliation(s)
- Wikrom Karnsakul
- Wikrom Karnsakul, Division of Pediatric Gastroenterology and Nutrition, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United State
| | | | | | | |
Collapse
|
9
|
Abstract
PURPOSE Idiopathic hypertrophic pyloric stenosis is a common surgical problem in infants, and pyloromyotomy is almost always successful in alleviating the obstruction. There are few reports in the literature that discuss recurrent pyloric stenosis as opposed to incomplete pyloromyotomy. We report 2 such babies with different cures. METHODS The health records department files were electronically searched for the number of infants at our children's hospital with hypertrophic pyloric stenosis seen over the past 30 years (1973-2003), and the recurrences were reviewed. RESULTS Recurrent pyloric stenosis was encountered in 2 cases (<0.07%). Balloon dilatation was first tried in both cases and was successful in 1 case; redo pyloromyotomy was required for the second case. CONCLUSION Recurrent pyloric stenosis is rare. Fluoroscopic balloon dilatation of the pylorus warrants further study as the first choice for curing this problem, and if unsuccessful, redo pyloromyotomy.
Collapse
Affiliation(s)
- Ahmed Nasr
- The Division of General Surgery and The Department of Interventional Radiology, The Hospital for Sick Children, Toronto, Ontario, Canada, M5G 1X8
| | | | | |
Collapse
|
10
|
Hagiwara A, Sonoyama Y, Togawa T, Yamasaki J, Sakakura C, Yamagishi H. Combined use of electrosurgical incisions and balloon dilatation for the treatment of refractory postoperative pyloric stenosis. Gastrointest Endosc 2001; 53:504-8. [PMID: 11275897 DOI: 10.1067/mge.2001.113281] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Drug therapy plus balloon dilatation without gastroscopic incision does not always relieve postoperative pyloric stenosis. METHODS Five patients with postoperative pyloric stenosis whose symptoms did not improve with drug therapy and balloon dilatation underwent a combination of gastroscopic incision and balloon dilatation. Two or 3 small radial incisions were made in the stenotic muscle of the pylorus electrosurgically at gastroscopy. Then the stenotic muscle layer was loosened and split bluntly along the incisions with balloon dilatation for 15 to 20 minutes. One week later, the combination procedure or balloon dilatation alone was repeated to prevent restenosis. RESULTS In the 5 patients, the stenosis was improved with the combination therapy. No complications were observed. CONCLUSIONS Combined use of gastroscopic incision and balloon dilatation may be considered for patients with refractory pyloric stenosis caused by surgical truncal vagotomy.
Collapse
Affiliation(s)
- A Hagiwara
- Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | | | | | | | | |
Collapse
|
11
|
Abstract
Acquired gastric outlet obstruction is more commonly owing to malignancy than ulcer disease. Endoscopy is the preferred method for diagnosis. Surgical palliation for malignant disease has poor results and high rates of morbidity and mortality. Initial experiences with endoscopic palliation with expandable metallic endoprostheses appear promising. Peptic ulcer-induced gastric outlet obstruction can be treated safely with endoscopic balloon dilation. About 65% of patients have sustained symptom relief, but many require more than one dilation session. Outcomes may be improved with effective ulcer therapy with acid reduction and eradication of H. pylori. Surgery is associated with significant morbidity and mortality and should be reserved for endoscopic treatment failures.
Collapse
Affiliation(s)
- S K Khullar
- Division of Gastroenterology, University of Utah School of Medicine and Health Sciences Center, Salt Lake City, USA
| | | |
Collapse
|
12
|
Ogawa Y, Higashimoto Y, Nishijima E, Muraji T, Yamazato M, Tsugawa C, Matsumoto Y. Successful endoscopic balloon dilatation for hypertrophic pyloric stenosis. J Pediatr Surg 1996; 31:1712-4. [PMID: 8986998 DOI: 10.1016/s0022-3468(96)90059-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The authors successfully applied endoscopic balloon dilatation for the treatment of hypertrophic pyloric stenosis (HPS). The patient was an infant girl who had undergone repair of a giant omphalocele. Endoscopic balloon dilatation was performed using a 9-mm endoscope and an 8-mm polyethylene terephthalate (PET) balloon dilator. Dilatation was performed three times for 10 minutes. Vomiting continued after the dilatation. At the second session, dilatation was performed using a 12-mm PET balloon dilator. The 9-mm endoscope then passed through the pylorus. The patient has had no episodes of vomiting since the second treatment. This procedure is an important therapeutic option for selected patients with HPS.
Collapse
Affiliation(s)
- Y Ogawa
- Department of Pediatric Surgery, Kobe Children's Hospital, Japan
| | | | | | | | | | | | | |
Collapse
|
13
|
Squires RH, Colletti RB. Indications for pediatric gastrointestinal endoscopy: a medical position statement of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr 1996; 23:107-10. [PMID: 8856574 DOI: 10.1097/00005176-199608000-00002] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- R H Squires
- Children's Medical Center, University of Texas Southwestern Medical Center at Dallas, USA
| | | |
Collapse
|
14
|
Abstract
Congenital and acquired pelviureteric junction obstruction (PUJ) were treated with balloon dilatation, using a Fogarty/Gruntzig catheter introduced through the cystoscope in 11 children (12 renal units). Stents were not used, and the hospitalization period was only 1 day for uncomplicated cases. Follow-up (maximum period, 4 1/2 years) has shown better drainage and function for all. In one child, who had solitary left kidney, acute obstruction developed; the patient underwent temporary percutaneous nephrostomy. Macroscopic hematuria was noted in one case, resulting in a 3-day hospital stay. Technical problems, advantages, and disadvantages are discussed. Retrograde ureteroplasty using balloon dilatation is a simple and effective procedure for children in whom the obstructed PUJ is in lower part of the pelvis.
Collapse
|
15
|
Dakkak M, Bennett JR. Balloon technology and its applications in gastrointestinal endoscopy. BAILLIERE'S CLINICAL GASTROENTEROLOGY 1991; 5:195-208. [PMID: 1854987 DOI: 10.1016/0950-3528(91)90012-p] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
16
|
Abstract
Balloon dilating catheters (BDC) have provided a non-operative means of managing obstructive lesions within the gastrointestinal tract. Its potential utility in infants with hypertrophic pyloric stenosis (HPS) was studied. Six patients with HPS underwent balloon catheter dilatation of the pylorus under the direct observation of the surgeon. The pylorus was exposed using a standard right upper quadrant incision. The BDC was passed transorally into the stomach and manipulated into the pyloric canal by the surgeon. The balloon was inflated with saline to a maximum pressure of 50 psi for 2 minutes. Four patients were dilated with a 10-mm diameter balloon catheter, and in two patients, a 15-mm balloon was used. Success was defined as the complete and longitudinal disruption of the seromuscular ring without violation of mucosal integrity. Using this criterion, none had successful pyloric dilatation. No disruption occurred in three patients, partial disruption in two. These patients subsequently underwent a Ramstedt pyloromyotomy. Complete disruption was observed in one; however, a breach of the mucosa was evident. This was repaired without incident. All seromuscular breaks occurred at the point of vascular entry along the lesser curve, presumably the weakest point of the ring. Pyloric dilatation using BDC does not reliably disrupt the muscular ring. This preliminary report recognizes that major refinements must occur before this method will supplant the time-honored surgical pyloromyotomy for HPS.
Collapse
Affiliation(s)
- A H Hayashi
- Department of Surgery, IWK Children's Hospital, Halifax, Nova Scotia, Canada
| | | | | | | |
Collapse
|
17
|
Kozarek RA, Botoman VA, Patterson DJ. Long-term follow-up in patients who have undergone balloon dilation for gastric outlet obstruction. Gastrointest Endosc 1990; 36:558-61. [PMID: 2279642 DOI: 10.1016/s0016-5107(90)71163-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Although balloon dilation for gastric outlet obstruction has supplanted vagotomy plus drainage or resective therapy in some institutions, there are no long-term data which demonstrate what percentage of patients ultimately requires surgical intervention. Of 23 evaluable patients treated with hydrostatic balloon dilation in our institution, 70% were asymptomatic at a mean follow-up of 2.5 years. Five patients required surgery--one for acute perforation and the other four for symptoms of continued obstruction, despite one to three additional attempts at dilation. Only three of seven patients with previous gastric resection had a satisfactory long-term result. Whereas endoscopic therapy initially cost one tenth to one fifth that of surgical intervention, such figures do not factor for loss of productivity, on the one hand, or potential need for chronic H2 blockade, on the other. Despite instruction to the contrary, only 6 of 15 (40%) active patients continue acid-suppressive therapy. We conclude that balloon dilation remains a viable alternative for selected patients with gastric outlet obstruction.
Collapse
Affiliation(s)
- R A Kozarek
- Section of Gastroenterology, Virginia Mason Clinic, Seattle, Washington 98111
| | | | | |
Collapse
|
18
|
|