Endoscopic features for early decision to evaluate superior mesenteric artery syndrome in children

Abstract

Background Diagnostic delay of superior mesenteric artery syndrome (SMAS) is common due to its rarity and lack of index of clinical suspicion. Early diagnosis under suspicion is pivotal for adequate treatment. Present study aims to explore the endoscopic features for early decision to evaluate SMAS in children. Methods In case controlled observation study, the recruitment was limited to patients who had endoscopic finding I or finding 1 plus more as follows: a pulsating vertical or oblique band or slit like luminal narrowing of the third part of the duodenum without no expansion over one third during air insufflation for at least 15 s (finding I), a marked dilation of the duodenal first and second part during air insufflation at the third part of the duodenum (finding II), a bile mixed fluid collection (bile lake) in the stomach (finding III). SMAS was confirmed with UGI series or hypotonic duodenography in enrolled patients. We analyzed positive endoscopic findings related with SMAS. Results The enrolled 29 patients consisted of 18 (62.1%) with SMAS and 11 (37.9%) without SMAS. The three most common presenting symptoms were abdominal pain, postprandial discomfort, and early satiety. The clinical impressions based on history and physical examination before endoscopy were functional dyspepsia (34.6%), gastritis or gastric ulcer (31.0%), and SMAS (17.3%). The constellation of three endoscopic findings (finding I + II + III, feature D) observed in 13 (72.2%) patients of SMAS group and 3 (27.3%) patients of non SMAS group (P = 0.027). Of 16 patients with features D, SMAS was diagnosed in 13 patients (81.2%) and not detected in 3 patients (18.8%) on UGI series or hypotonic duodenography. Conclusions Endoscopic examination to the third part of the duodenum can provide a clue making a decision to evaluate SMAS, which consists of features of three endoscopic findings as follows: a pulsating vertical or oblique band or slit like luminal narrowing of the third part of the duodenum without no expansion over one third during air insufflation for at least 15 s, a marked dilation of the first and second part of the duodenum, and a bile lake in the stomach.

Superior Mesenteric Artery Syndrome Results From Hypersecretion of Hydrochloric Acid

“…The endoscopic suspicion of SMAS was a constellation of three findings: (1) pulsating vertical or oblique band or slit like luminal narrowing of the third part of the duodenum with luminal expansion no more than one third during air insufflation over 15 s, (2) proximal duodenal over distension during air insufflation, (3) bile lakes in the stomach. The authors diagnosed SMAS based on the following radiological signs: (1) gastroduodenal dilatation with delayed gastric and duodenal emptying, (2) abrupt vertical or oblique cutoff of contrast shadow at the third part of the duodenum (3) 'to and fro' flow of contrast from the proximal to the obstruction [21].…”

Early Identification of Chronic Mesenteric Ischemia with Endoscopic Duplex Ultrasound

“…Standards for E-DUS procedure were followed. 22 , 23 All patients were in at least 6 hours of fasting state before the examination. All procedures were performed under conscious sedation with midazolam (mean 3.35 mg) and alfentanil (mean 0.77 μg).…”