title: Balloon dilatation in patients with gastric outlet obstruction related to peptic ulcer disease.
abstract: OBJECTIVE
  Gastric outlet obstruction (GOO) is a rare complication of peptic ulcer disease (PUD). The endoscopic balloon dilatation (EBD) associated with medical treatment of Helicobacter pylori is a successful method in the management of pyloric stenosis. The aim of this study was to describe epidemiological, clinical, and endoscopic characteristics of GOO related to PUD and to evaluate the effectiveness, safety, and outcome of EBD.
  
  
  METHODS
  In a retrospective study of patients seen between 1999 and 2009 with symptoms of GOO secondary to PUD, pyloro-bulbar stenosis was confirmed by endoscopic examination. Balloon dilatation was performed when obstruction persisted after treatment with double-dose proton-pump inhibitor (PPI) intravenously for 7-10days. The H. pylori status was assessed with histology, and eradication therapy was prescribed for infection.
  
  
  RESULTS
  A total of 45 consecutive patients (38 males, 7 females median age, 51.9years; range, 20-58years) with symptoms of GOO secondary to PUD underwent EBD. Median follow-up time of the 45 patients was 32months (range, 4-126months). The immediate success rate of the procedure was 95.5%. Clinical remission was noted in 84.4% of the patients. Remission without relapse was observed in 55.8%, 30months after the dilatation. Pyloric stenosis relapsed in 15 patients (39.5%) after a median period of 22.9months. The dilatation was complicated in three patients (6.7%, two perforations and one bleeding). A total of 13 patients (29%) underwent surgery. H. pylori was found to be positive in 97.7% of the patients, and was eradicated in 78.4% of them. Smoking and failure of H. pylori eradication were associated with the relapse of the stenosis.
  
  
  CONCLUSIONS
  EBD is a simple, effective, and safe therapy for the GOO related to PUD, producing short- and long-term remission.
authors.affiliation: Gastroenterology Department, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia. Electronic address: lamine015@yahoo.fr.
authors.forename: Lamine
authors.initials: L
authors.lastname: Hamzaoui
authors.affiliation: General Surgery Department, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.
authors.forename: Mahdi
authors.initials: M
authors.lastname: Bouassida
authors.affiliation: Gastroenterology Department, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.
authors.forename: Imed
authors.initials: I
authors.lastname: Ben Mansour
authors.affiliation: Gastroenterology Department, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.
authors.forename: Mouna
authors.initials: M
authors.lastname: Medhioub
authors.affiliation: Gastroenterology Department, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.
authors.forename: Heykal
authors.initials: H
authors.lastname: Ezzine
authors.affiliation: General Surgery Department, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.
authors.forename: Hassen
authors.initials: H
authors.lastname: Touinsi
authors.affiliation: Gastroenterology Department, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.
authors.forename: Mohamed M
authors.initials: MM
authors.lastname: Azouz
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004106:Dilatation; D005260:Female; D005500:Follow-Up Studies; D017219:Gastric Outlet Obstruction / Q000209:etiology* / Q000628:therapy*; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000150:complications*; D012008:Recurrence; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Balloon dilation; Duodenal ulcer; Endoscopy; Gastric outlet obstruction; Helicobacter pylori