Adult idiopathic hypertrophic pyloric stenosis: an infrequent cause of gastric outlet obstruction

Hypertrophic pyloric stenosis is a congenital disease, presenting within two weeks of birth. However adult idiopathic hypertrophic pyloric stenosis (AIHPS) presents in middle age, predominantly in males and usually without any antecedent cause. Secondary variant may be due to intra gastric causes or extra gastric post-operative adhesions. Patient presents with symptoms of gastric outlet obstruction. Diagnosis depends on clinical, radiological and endoscopic findings. Treatment is subtotal gastrectomy. Pyloroplasty and endoscopic dilatation may be tried in debilitated patients. We present a case of AIHPS presenting as gastric outlet obstruction in a 16 year old female, that was surgically managed with an antrectomy.

Comparison of endoscopic balloon dilatation and endoscopic stricterotomy in the treatment of postopera-tive anastomotic stenosis of colorectal cancer / 实用医学杂志

Objective Comparing the efficacy of endoscopic balloon dilatation and endoscopic stricteroto-my for postoperative anastomotic stenosis of colorectal cancer. Methods Retrospectively analyzed the clinical data of patients with postoperative anastomotic stenosis of colorectal cancer that underwent anastomotic dilatation from 2013 to 2016,and analyzed the anastomotic stenosis before and after treatment,and compared the efficacy of the two groups of dilatation methods. Results There was no statistically significant difference between the two groups in baseline characteristics. Balloon dilatation was effective in 3 cases(23.1%),ineffective in 10 cases(76.9%). 7 cases(63.6%)were effective in the stricterotomy group,4 cases(36.4%)were ineffective,the difference was statistically significant(P=0.045).Two groups of patients were not bleeding after surgery,infection and perfora-tion and other complications. Conclusion Endoscopic stricterotomy of postoperative anastomotic stenosis of colorectal cancer is more effective than conventional endoscopic balloon dilatation

Endoscopic balloon dilatation of esophageal stricture and esophageal achalasia in children / 中国内镜杂志

Objective To assess the safety, effectiveness and predictive factors of endoscopic balloon dilatation for the treatment of esophageal stricture and esophageal achalasia in children. Methods 28 patients with esophageal stricture and esophageal achalasia treated by endoscopic balloon dilatation from January 2012 to November 2014 were included. All the patients were divided into two groups, 22 in group A (esophageal stricture) and 6 in group B (esophageal achalasia). All procedures were performed under tracheal intubation and intravenous anesthesia using the 3rd grade controlled radial expansion (CRE) balloon with gastroscope. Outcomes, including success, complications and recurrence data were recorded, and predictors for outcomes were analyzed. Results A total of EBD 57 sessions (1 to 5 per patient, 2.00 ± 1.15) were performed on 28 patients in this study. 22 patients were diagnosed with esophageal stricture (78.57%) and 6 with esophageal achalasia (21.43%). The median age was 25 months (range 0 ~ 150), and female/ male ratio was 12/16. EBD was successful in all the 28 cases. The total success rate was 100.00%. Complications occurred in 6 patients during the dilatation, and no complication in 22 patients. Completely remission of symptoms was seen in 82.14% cases (n = 23), relief in 14.28% (n = 4), non-response in 3.57% (n = 1), and recurrence in 3.57% (n = 1). The stricture diameter before EBD was (6.28 ± 1.77) mm (range 3.0 ~ 10.0 mm), and it was (10.85 ± 2.51) (range 6 ~ 15 mm) after the last EBD. The difference was significant (P 0.05). The effectiveness of EBD was significantly associated with the diameter and number of strictures (P 0.05). Conclusions The results of this study indicated that EBD under general anesthesia was an effective primary treatment in children with esophageal stricture and esophageal achalasia. The diameter and number of stricture were the most important predictive factors for successful clinical outcomes, while the interval between surgery and the first EBD was the most risk factor for EBD sessions in the patients with anastomotic esophageal strictures.

A Case of Metabolic Encephalopathy Due to Bleeding after EPBD / 대한췌담도학회지

Endoscopic retrograde cholangiopancreatography is widely used for diagnosis and treatment of pancreatobiliary diseases and associated with a spectrum of complications such as pancreatitis, hemorrhage, and so on. Endoscopic papillary balloon dilatation (EPBD) has an advantage over endoscopic sphincterotomy in complication of bleeding. We report here on a 68-year-old woman who developed metabolic encephalopathy due to massive bleeding after EPBD. Massive bleeding was controlled after selective embolization and metabolic encephalopathy was improved after conservative management. Metabolic encephalopathy due to massive bleeding after EPBD has not been reported. We report on this unusual case along with a review of the related literatures.

A Case of Hepatic Portal Venous Gas as a Complication of Endoscopic Balloon Dilatation

The development of hepatic portal venous gas (HPVG) is rare but it might be associated with serious disease and poor clinical outcome. Recently, several iatrogenic causes of HPVG have been reported. HPVG as a complication of endoscopic balloon dilatation is a previously unreported event. We experienced a case of HPVG after endoscopic balloon dilatation in a 31 yr-old man with pyloric stricture due to corrosive acids ingestion. The patient was treated conservatively with fluid resuscitation, antibiotics and Levin tube with natural drainage. Five days later, the follow-up CT scan showed spontaneous resolution of HPVG. This case reminded us the clinical importance and management strategy of HPVG. We report here a case of iatrogenic HPVG with a review of relevant literature.

Treatment of common duct stones in patients with atypical papillae using small endoscopic sphincterotomy and endoscopic balloon dilatation / 中华肝胆外科杂志

Objective To evaluate the effect of small endoscopic sphincterotomy and endoscopic balloon dilatation in the treatment of common duct stones (CDS) in patients with atypical papillae (combined with diverticula; after surgical operation; combined with abnormal duodenal lumen with no definite cause).MethodsOne hundred and three patients with CDS and with atypical papillae treated from July 2007 to March 2010 were randomly divided into three groups.Thirty-four patients received endoscopic sphincterotomy (EST group),34 patients received endoscopic balloon dilatation (EBD group) and the remaining 35 patients received small endoscopic sphincterotomy and endoscopic balloon dilatation (EST+EBD group).The general state of the patients in the 3 groups showed no significant difference (P＞0.05).We tried to remove all CDS using baskets and/or balloons after the procedures on the papillae.In some patients the stones were crushed by using a basket mechanical lithotriptor (BML).In some patients with huge stones,we could only placed in a plastic stent because of the high risk of removing the stones in a single procedure.ResultsSuccessful endoscopic retrograde cholangiopancreatography (ERCP) was carried out in 96 patients.Patients in the EST+ EBD group had less complications,especially hemorrhage,when compared with the EST group (P＜0.05).Also,the EST+EBD group had a significantly higher success rate of complete stone removal (P＜0.05),decreased use of BML (P＜0.05) and decreased rate of acute pancreatitis when compared with the EBD group (P＜0.05).ConclusionsThe success rate of ERCP in managing patients with CDS with atypical papillae remained high.Small endoscopic sphincterotomy and endoscopic balloon dilatation had a higher success rate of removing stones at the first attempt and a decreased rate of complications.

Endoscopic Balloon Dilatation in Children with Congenital and Acquired Esophageal Anomalies / 대한소아소화기영양학회지

PURPOSE: To evaluate the safety, efficacy and technical problems of the endoscopic balloon dilatation of esophageal anomalies in children. METHODS: The medical records of 8 children treated by endoscopic balloon dilatation for esophageal anomalies over a 10-year period at Pusan National University Hospital were reviewed retrospectively. The balloon catheter (Maxforce TTS or CRE, Boston Scientific Co., USA) was positioned across the area of narrowing by direct visualization. The balloon was slowly inflated with normal saline to specified pressures for each balloon and maintained for 60 seconds and then deflated. After 60 seconds pause, the procedure was repeated with a larger sized balloon (increments of 1 mm for each subsequent dilation) till effective dilatation was confirmed by direct visualization without complications. RESULTS: Three male and five female were included and their mean age was 4.2 years. A total of 27 (average of 3.2 per patient) dilatation were performed. Underlying diseases of patients are postoperative stricture of esophageal atresia in 3 cases, esophageal ring in 2 cases, achalasia, corrosive esophagitis and hypertensive LES in one case respectively. The size of initial dilating balloon was chosen on the basis of the diameter of the narrowing determined by endoscopy. The first dilation in patients with severe esophageal stricture was made with a 6 mm sized balloon. Complications observed were esophageal perforation and respiratory holding during the procedure in one case respectively. Successful outcome was seen in 6 patients (75%). CONCLUSION: Endoscopic balloon dilatation can provide a safe and effective mean of treating esophageal anomalies in children and should be considered the treatment of choice in the initial management of those cases.

A Case of Plummer-Vinson Syndrome / 대한소화기내시경학회지

The combination of symptomatic hypopharyngeal webs and iron-deficiency anemia in middle-aged women constitutes Plummer-Vinson syndrome. It is uncommon but important syndrome because of inceased risk of squamous cell carcinoma of the pharynx and esophagus. The cause of this syndrome is still not clear. A small sized web is treated by correction of anemia, but a large sized one with dysphagia is treated by breakage of web. Recently, we experienced a 41-year-old woman with Plummer-Vinson syndrome. She complained of dysphagia for 10 years. Esophagogram and endoscopic examination showed a hypopharyngeal web and peripheral blood profile was compatible with iron-deficiency anemia. Her symptom improved after endoscopic balloon dilatation of the upper esophageal web.

Long-Term Outcome of Endoscopic Balloon Dilatation of Benign Pyloric Stricture / 대한소화기내시경학회지

BACKGROUND/AIMS: Balloon dilatation is a useful alternative to surgery in patients with benign pyloric stenosis. However, little data are available on the long-term outcome of the procedure. This report was attempted to determine the safety and efficacy of endoscopic balloon dilatation for 14 patients with gastric outlet obstruction caused by duodenal ulcer. METHODS: Review of medical records or telephone interview was performed retrospectively. RESULTS: Follow-up was conducted for median 18.5 months (3-48 months). Gastric outlet strictures had a median diameter 6 mm (range, 2-9 mm). Five (35.7%) patients had active ulcer. 12 mm to 18 mm balloons were inflated a median of 1 times (range, 1-4 times) for a median of 4 minutes (range, 1-11 minutes). Thirty-two procedure (1.5/patient) were performed; 9 patients (64.3%) had one treatment and 5 patients (35.7%) had multiple treatment. Immediate symptomatic relief was achieved in 13 patients (92.8%) and 7 patients (50%) achieved sustained symptomatic relief. Dilatation failed only in 2 patients (14.3%) ultimately and both recovered by palliative bypass surgery. No complication was noted during treatment. CONCLUSIONS: Endoscopic balloon dilatation is safe and effective for most patients with gastric outlet obstruction induced by duodenal ulcer. And due to limitation of retrospective aspect of this report, further prospective, randomized studies must be performed.

A Case of Successful Management of Hypertrophic Pyloric Stenosis with Endoscopic Balloon Dilatation

Endoscopic balloon dilatation has provided a non-operative means of managing obstructive lesions in the gastrointestinal tract. In an infant with idiopathic hypertrophic pyloric stenosis(IHPS), the stenosis was successfully dilated with endoscopic balloon dilatation. Endoscopic balloon dilatation was performed using a 9mm endoscope and through-the-scope(TTS) balloon catheter (diameter 10 to 12mm). Dilatation was performed two times for 5 minutes. The 9mm endoscope then passed through the pylorus. There were no complications. The treatment was followed by immediate symptomatic relief. Endoscopic balloon dilatation may become a valid alternative to surgical procedures for the treatment of IHPS if good results can be confirmed in further studies.