Endoscopic balloon dilatation without fluoroscopy for treating gastric outlet obstruction because of benign etiologies.
BACKGROUND
Benign gastric outlet obstruction (GOO) causes considerable morbidity and conventional treatment has been surgery. Endoscopic balloon dilatation is a minimally invasive treatment modality for GOO but experience with its use is mainly in patients with GOO due to peptic ulcer disease. We report our experience of endoscopic balloon dilatation in benign GOO of various etiologies.


METHODS
Over 4 years, 25 patients with benign GOO were treated by endoscopic balloon dilatation done with through-the-scope controlled radial expansion (CRE) balloon dilators. Dilatation was repeated every 2 weeks with the end point being dilation of 15 mm or the need for surgery. Helicobacter pylori, when present, was eradicated.


RESULTS
Etiology of benign GOO was peptic ulcer (11), corrosive ingestion (7), chronic pancreatitis (4, groove pancreatitis in 1), tuberculosis (2), and Crohn's disease (1). Endoscopic balloon dilatation was successful in 21/25 (84%) patients. Patients required one to six sessions of endoscopic dilatation (mean=2.2±1.2). Corrosive-induced GOO required more dilatation sessions (3.83±0.75) compared to peptic GOO (2.1±0.56; p<0.05). Balloon dilatation was also effective in patients with GOO due to gastroduodenal tuberculosis and Crohn's disease. Patients with chronic pancreatitis-related GOO had poor response to dilatation, with two patients (50%) requiring surgery and the remaining two with recurrence of symptoms requiring repeat dilatation. None of the other patients with successful treatment had recurrence of symptoms. Complication in the form of perforation was noted in two patients (8%).


CONCLUSIONS
Endoscopic balloon dilatation is an effective, safe, and minimally invasive treatment modality for benign gastric outlet obstruction.
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India. drsurinderrana@yahoo.co.in
Surinder Singh
SS
Rana
Deepak Kumar
DK
Bhasin
Vijant Singh
VS
Chandail
Rajesh
R
Gupta
Ritambhra
R
Nada
Mandeep
M
Kang
Birinder
B
Nagi
Rajinder
R
Singh
Kartar
K
Singh
D000328:Adult; D002057:Burns, Chemical / Q000150:complications; D002404:Catheterization; D002424:Caustics / Q000009:adverse effects; D002908:Chronic Disease; D005260:Female; D005471:Fluoroscopy; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000628:therapy*; D005773:Gastroscopy; D006801:Humans; D008297:Male; D010195:Pancreatitis / Q000150:complications; D010437:Peptic Ulcer / Q000150:complications; D013270:Stomach / Q000293:injuries
D002424:Caustics