Avoiding Surgery: Endoscopic Treatment of Congenital Duodenal Stenosis.

Duodenal stenosis is a rare congenital anomaly that is typically treated surgically, although endoscopic incisional therapy (EIT) and balloon dilation are minimally invasive alternatives. We present a case of a 15-month-old male with vomiting and difficulty tolerating solid food due to severe congenital duodenal stenosis. The patient underwent EIT and serial duodenal dilation to a diameter of 20 mm, which resulted in significant symptom improvement. Intralesional corticosteroid injection (ISI) was administered to help prevent the duodenal septum from restricturing. The combination of EIT, balloon dilation, and ISI was successful in treating the patient's congenital duodenal stenosis and avoided the need for surgery. However, further studies are required to confirm the efficacy of this treatment approach in this patient population. This report highlights the potential of this minimally invasive approach as an alternative to surgical intervention in the management of congenital duodenal stenosis.

Esophageal polyp in a teenage boy with eosinophilic esophagitis.

The association of eosinophilic esophagitis and esophageal polyps has been reported in the literature but remains a rare finding in both adults and children. The patient in this case report presented with progressively worsening dysphagia secondary to eosinophilic esophagitis and an esophageal polyp. Dysphagia is always abnormal, and endoscopic evaluation is essential. Dysphagia is a well-known symptom in patients with eosinophilic esophagitis. While esophageal polyps as a whole are less common in the pediatric population, they should not be overlooked as a possible cause of dysphagia and esophageal obstruction.

Gastrointestinal Conditions in Children With Severe Feeding Difficulties.

Feeding aversion in children may progress to severe feeding difficulties. While oral-motor and sensory issues are usually the leading causes, organic etiologies should be considered. This study aimed to assess the prevalence of gastrointestinal conditions in children with severe feeding difficulties. We conducted a retrospective study of 93 children requiring an intensive feeding program. The medical records, radiologic and diagnostic tests, use of gastric tube feedings, preexisting medical conditions, and medications were reviewed. Fifty-two percent (52%) had esophagitis, 26.2% gastritis, and 40.7% lactase deficiency in upper endoscopy. In those who underwent an upper endoscopy, 26% of patients that were also tested for small intestinal bacterial overgrowth were found to be positive. Allergy testing was abnormal in 56.6% of those tested, while 27.5% and 75% had abnormal gastric emptying times and pH impedance results, respectively. Constipation was present in 76.3%. Thirteen of 32 were weaned off tube feedings. We conclude that gastrointestinal conditions are common in children with feeding disorders and should be investigated prior to feeding therapy.