Long-term Results of Endoscopic Balloon Dilatation for Gastric Outlet Obstruction Caused by Peptic Ulcer Disease

Abstract

BACKGROUND Gastric outlet obstructions (GOO) is a disabling complication of peptic ulcer disease (PUD). The introduction of endoscopic through the scope balloon dilatation (EBD) has eased the management but there are few reports on the long term results of this modality of treatment on patients’ symptoms. METHODS Over a period of 4 years from January 2012 to December 2015 in two major referral hospitals affiliated to Shiraz university, medical endoscopy reports were reviewed retrospectively to identify those who received EBD for the treatment of GOO due to PUD .All of these patients were recalled and their current status were evaluated. RESULTS 22 consecutive patients with symptomatic GOO secondary to benign stricture underwent endoscopic balloon dilatation by a single operator. Of them, 14 had balloon dilatation twice and 6 had ballooning three times. The interval between the first referral and the last follow-up was 25.2 ± 10.3 (min: 4.8 max:43.4) months. The averages of maximum balloon size were 14.4 ± 5 mm in the first session, 14.3 ± 3.1mm in the second session, and 16 ± 2.4 mm in the third session. 73% of the patients had a significant improvement in clinical symptom with two sessions of EBD and did not require repeat dilatation. CONCLUSION EBD is a safe and efficient method in the management of GOO with good long term results.

Gastric outlet obstruction secondary to adult hypertrophic pyloric stenosis: case report and literature review

“…2,4,6,10 Regarding endoscopic dilation, surgery is indicated if the pylorus is obstructed and cannot be safely dilated, or if the obstruction persists or recurs despite endoscopic dilations to achieve a diameter of 15 mm, symptoms usually improve considerably with successful dilation of 12 to 15 mm. 3 In the case presenting with the recurrence of AHPS and the impossibility of dilating it Some authors prefer partial gastrectomy with Billroth I reconstruction because carcinoma can be a complication of long-standing pyloric hypertrophy. 5,6 Approximately 25 percent of gastric cancer patients have a history of gastric ulcer related to Helicobacter pylori infection.…”

“…2 Chronic peptic ulcer resulting in gastric outlet obstruction is the least common complication, occurring in approximately 2 percent of cases. 3 Patients with secondary AHPS often do not present any symptoms. 4 Diagnosing hypertrophic stenosis in adults remains a challenge; differentiation between primary and secondary pyloric stenosis is made by histopathological report.…”

Gastric outlet obstruction secondary to peptic ulcer disease, previously misdiagnosed as idiopathic hypertrophic pyloric stenosis in a 16-year-old girl: a case report

“…Some authors reported that the introduction of endoscopic balloon dilation has simplified the treatment of benign gastric outlet obstruction due to peptic ulcer disease and is associated with favourable long-term outcome. Moreover, it is now considered to be the first-line treatment [ 3 , 8 ].…”

Causes of upper gastrointestinal tract obstruction

“…Relapses are less common after successful eradication of H. pylori (26) . Clinical improvement after endoscopic balloon dilation is estimated at about 70% (27) . In the absence of H. pylori infection, the rate of endoscopic failures is higher.…”