Idiopathic non-hypertrophic pyloric stenosis in an infant successfully treatedviaendoscopic approach

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.

Uncommon Cause of Chronic Vomiting in Children

“…In 2008, Sharma et al stated that pneumatic dilatation of the pylorus might be the best treatment modality for primary acquired GOO in infancy and childhood [ 13 ]. Later, in 2010, Karnsakul et al cured an 18-month-old boy with non-peptic, non-hypertrophic pyloric stenosis after three sessions of endoscopic pyloric balloon dilatation [ 14 ]. Jawaid et al found no difference in regard to symptomatic improvement after pneumatic dilatation [ 5 ].…”

“…Later, in 2010, Karnsakul et al cured an 18-month-old boy with non-peptic, non-hypertrophic pyloric stenosis after three sessions of endoscopic pyloric balloon dilatation [14]. Jawaid et al found no difference in regard to symptomatic improvement after pneumatic dilatation [5].…”

Successful combination of endoscopic pyloromyotomy and balloon dilatation for hypertrophic pyloric stenosis in an older child: A novel procedure

“…Although the outcome of balloon dilatation for HPS in infants is not preferable, it has been reported that balloon dilatation is effective for gastric outlet obstruction (GOO) and pyloric stenosis (PS) in adults or older children [10–14]. However, the combination of EP and EPBD for HPS has not been reported on.…”

Endoscopic Treatment for Nonhypertrophic Idiopathic Pyloric Stenosis in an Adolescent Patient

“…On the other hand, endoscopic pyloric dilation, repeated in several sessions, has been described as successful. 3 Finally, surgical procedures are reserved in case of medical and endoscopic treatment failure. Here, we present the case of an adolescent male with a history of chronic vomiting secondary to NHIPS managed with endoscopic dilations and jejunal feeding.…”