Endoscopic balloon dilation in caustic-induced chronic gastric outlet obstruction

doi:10.1016/j.gie.2008.05.056

Gastrointestinal Endoscopy

Volume 69, Issue 4, April 2009, Pages 800-805

https://doi.org/10.1016/j.gie.2008.05.056 Get rights and content

Background

The standard treatment of caustic-induced gastric outlet obstruction (GOO) is surgery. There are only a few reports in the medical literature on endoscopic balloon dilation (EBD) for caustic-induced GOO.

Objective

To study the short-term and long-term response of EBD in patients with caustic-induced GOO.

Setting

Tertiary-care center in India.

Design

Retrospective analysis of data.

Patients

Of the 49 patients with caustic-induced GOO seen by us between January 1998 and December 2003, 41 were treated by EBD. Thirty-seven patients had consumed an acid and 4 had consumed an alkali a mean (SD) of 19.5 ± 14.5 weeks earlier. EBD was performed every 3 weeks by using through-the-scope balloons under endoscopic guidance.

Intervention

The balloon was negotiated across the narrowed segment and inflated for 60 seconds by using a pressure gun. Balloons of incremental diameters, up to a maximum of 3 sizes, were used in each sitting. The end point of dilation was 15 mm, after which patients were assessed for recurrence. The patients were observed until August 2007.

Results

All 41 patients (23 men; mean [SD] age 29.6 ± 8.5 years) could be successfully taken for EBD. Thirty-nine patients underwent successful repeated dilations, which required a mean (SD) of 5.8 ± 2.6 dilations (range 2-13) to achieve the end point of 15 mm. All 39 patients were followed up for an average (SD) of 35.4 ± 11.1 months (range 18-58 months). The mean (SD) size of the first dilator was 8.2 ± 0.6 mm (range 8-10 mm). One patient had a perforation and was subjected to antrectomy; another patient had pain every time he received EBD; he also had surgery. Other complications were minor: self-limiting pain (n = 8) or bleeding (n = 7).

Conclusions

EBD is a safe, effective, and long-lasting alternative to surgery for caustic-induced GOO.

Section snippets

Patients and methods

Between January 1998 and December 2003, all consecutive patients with symptomatic caustic-induced chronic (ingestion of caustic substance more than 8 weeks earlier) GOO were evaluated. Patients who satisfied the selection criteria were subjected to EBD by using through-the-scope (TTS) balloon dilators. Inclusion criteria were (1) symptomatic GOO with postprandial vomiting and (2) narrowing of the pyloroantral area on gastroscopy and barium meal examination. Patients with (1) >6-cm length of

Results

Of the 49 patients with caustic-induced GOO seen by us, 8 were excluded because of various reasons (>6-cm esophageal stricture [2 patients], >2.5-cm pyloroantral narrowing [3], the presence of active ulceration [2], and mentally unstable patient [1]). The mean (SD) age of the 41 patients included in the study was 29.63 ± 8.53 years (Table 1). Eighteen patients had consumed sulfuric acid, 12 ingested hydrochloric acid, 3 ingested nitric acid, and 4 ingested other acids, whereas 4 patients had

Discussion

EBD was technically successful in all 41 patients included in the study, and the procedural end point of dilation to 15 mm could be achieved in 39. Over a follow-up of 18 o 58 months, all the patients remained symptom free. Only one major complication, in the form of perforation, was encountered. There was no procedure-related mortality.

Of the 41 patients, placement of a balloon across the narrowing was possible in all of them. Apart from the first 5 patients, we did not use fluoroscopy, and,

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Cited by (38)

ASGE guideline on the role of endoscopy in the management of benign and malignant gastroduodenal obstruction
2021, Gastrointestinal Endoscopy
This American Society for Gastrointestinal Endoscopy guideline provides evidence-based recommendations for the endoscopic management of gastric outlet obstruction (GOO). We applied the Grading of Recommendations, Assessment, Development and Evaluation methodology to address key clinical questions. These include the comparison of (1) surgical gastrojejunostomy to the placement of self-expandable metallic stents (SEMS) for malignant GOO, (2) covered versus uncovered SEMS for malignant GOO, and (3) endoscopic and surgical interventions for the management of benign GOO. Recommendations provided in this document were founded on the certainty of the evidence, balance of benefits and harms, considerations of patient and caregiver preferences, resource utilization, and cost-effectiveness.
Etiological spectrum and response to endoscopic balloon dilation in patients with benign gastric outlet obstruction
2018, Gastrointestinal Endoscopy
Peptic ulcer disease (PUD)–related gastric outlet obstruction (GOO) is known to respond favorably to endoscopic balloon dilation (EBD). However, data on efficacy of EBD for other etiologies of benign GOO are sparse. We aimed to compare the response of EBD among different etiologies of GOO.
Records of all patients with benign GOO who underwent EBD at our tertiary-care center between January 1998 and December 2017 were analyzed. Dilation was done by using through-the-scope balloons. Procedural and clinical success of EBD was compared among different etiologies.
A total of 306 patients were evaluated, of whom 264 (mean [± standard deviation] [SD] age 37.89 ± 17.49 years; men 183, women 81) underwent dilation. Etiologically, caustic ingestion was the commonest cause of GOO (53.8%) followed by PUD (26.1%) and medication-induced (8.3%). Overall procedural and clinical success was achieved in 200 (75.7%) and 243 (92.04%) patients, respectively, requiring a mean (± SD) of 2.55 (2.8) and 5.37 (3.9) sessions, respectively. Caustic-induced GOO responded less favorably, requiring a higher number of dilation sessions and having more refractory strictures than other etiologies. Medication-induced GOO performed worse than PUD-related GOO. Of the 264 patients, 9 (3.4%) had perforations during EBD, 3 had contained leaks and were managed conservatively, and 6 underwent successful surgery.
EBD is successful in a majority of patients with benign GOO, with caustic-induced GOO and medication-induced GOO being more difficult than PUD-related GOO.
Surgical management of corrosive-induced gastric injury in children: 10 years' experience
2018, Journal of Pediatric Surgery
Citation Excerpt :
An upper gastrointestinal endoscopy or a barium meal is a good means of evaluating the extent and nature of the gastric injury [21]. There are a few reports that documented the efficacy of endoscopic balloon dilatation in patients with corrosive pyloric stenosis [17,23]. However, this approach is associated with high failure and complication rates [24].
The purpose of this study was to report surgical management and outcome of corrosive-induced gastric injuries in children at our institute over the last decade.
Medical records of patients admitted for corrosive-induced gastric injury at the Pediatric Surgery Department of Ain Shams University between January 2007 and January 2017 were retrospectively reviewed.
Twenty six cases (17 boys and 9 girls) were enrolled. Mean age was 3.61 ± 1.29. Ingested agent was acid in all the patients. Main presenting symptom was gastric output obstruction in 22 cases. The interval between corrosive ingestion and presentation ranged from one to 135 days (mean = 43.9 ± 34). Surgical procedure included total gastrectomy (n = 2), partial gastrectomy (n = 2), augmentation gastroplasty (n = 1), Billroth I (n = 2), antrectomy (n = 2), antroplasty (n = 3), gastrojejunostomy (n = 2), Heineke–Mikulicz pyloroplasty (n = 9), Finney pyloroplasty (n = 5), and feeding jejunostomy (n = 4). Anastomotic stricture requiring a second operation developed in one patient. There were three mortalities related to the associated esophageal strictures. The mean follow-up period is 3.5 years. All patients are free of symptoms and gained adequate weight.
Surgery is the mainstay of management for corrosive-induced gastric injuries with good long-term results. Surgical procedure should be tailored according to the patient's general condition and extent of gastric injury.
This is a case series with no comparison group (level IV).
Per-Oral Pyloromyotomy (POP). An Emerging Application of Submucosal Tunneling for the Treatment of Refractory Gastroparesis
2016, Gastrointestinal Endoscopy Clinics of North America
Citation Excerpt :
Following esophagectomy with gastric interposition, benign gastric outlet obstruction (which affects approximately 15% of patients) has been described as benefitting from surgical pyloroplasty or pyloromyotomy, although it can also be treated with endoscopic balloon dilation.8–11 Pyloric disruption by endoscopic balloon dilation can also be used to treat obstruction from chronic ulcers or caustic stricture,12–14 although in these settings definitive treatment often requires surgery. Endoscopic self-expanding metallic stents are another intriguing possibility for treating both benign pyloric stenosis and gastroparesis.
The role of endoscopy in gastroduodenal obstruction and gastroparesis
2011, Gastrointestinal Endoscopy
Endoscopic Dilation of Corrosive Strictures: Is It Safe?
2022, Digestive Diseases and Sciences

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: DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

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Original articleClinical endoscopyEndoscopic balloon dilation in caustic-induced chronic gastric outlet obstruction

Background

Objective

Setting

Design

Patients

Intervention

Results

Conclusions

Section snippets

Patients and methods

Results

Discussion

Gastroenterology

Am J Surg

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

The natural history of corrosive gastritis: report of five cases

Am J Dig Dis

Gastric outlet obstruction due to corrosive ingestion: incidence and outcome

Pediatr Surg Int

Ingestion of strong corrosive alkalis: spectrum of injury to upper gastrointestinal tract and natural history

Am J Gastroenterol

Original article
Clinical endoscopy
Endoscopic balloon dilation in caustic-induced chronic gastric outlet obstruction