Update on endoscopic management of gastric outlet obstruction in children

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.

Gastric Outlet Obstruction Secondary to Pyloric Thickening in an Adolescent Male

“…In recent decades, prevalence has been given to laparoscopic gastrojejunostomy, which is a minimally invasive procedure that results in less postoperative pain and a shorter recovery time for patients. 18 If the patient has been given a poor prognosis and a limited life expectancy, surgical repair may not be an option. Administering nutrition through a nasogastric feeding tube or the placement of a stent through the stricture is an option to keep the patient comfortable in these cases.…”

Tratamiento endoscópico de la obstrucción del tracto de salida gástrico de origen péptico-cicatricial en un niño de 4 años

“…La cicatrización y la remodelación tisular pueden causar OTS en la úlcera péptica crónica. 4 Tradicionalmente, la cirugía ha sido el modo de tratamiento estándar para la OTS relacionada con la UP (vagotomía con piroloplastia, antrectomía o gastroyeyunostomía y Billroth I, Billroth II o piloroplastia), pero está asociada a mayor morbimortalidad.…”

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

“…There are concerns about the physiological effects of these procedures, which could result in reducing quality of life. 9 The introduction of endoscopic through the scope balloon dilation (EBD) has simplified the treatment without the need for surgery. 9 Although there is risk of perforation in complex strictures, it is considered more physiological treatment with overall less hazards for the patients.…”

“…9 Although there is risk of perforation in complex strictures, it is considered more physiological treatment with overall less hazards for the patients. 9…”