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      Long-term Results of Endoscopic Balloon Dilatation for Gastric Outlet Obstruction Caused by Peptic Ulcer Disease

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          Abstract

          BACKGROUND

          Gastric outlet obstructions (GOO) is a disabling complication of peptic ulcer disease (PUD). The introduction of endoscopic through the scope balloon dilatation (EBD) has eased the management but there are few reports on the long term results of this modality of treatment on patients’ symptoms.

          METHODS

          Over a period of 4 years from January 2012 to December 2015 in two major referral hospitals affiliated to Shiraz university, medical endoscopy reports were reviewed retrospectively to identify those who received EBD for the treatment of GOO due to PUD .All of these patients were recalled and their current status were evaluated.

          RESULTS

          22 consecutive patients with symptomatic GOO secondary to benign stricture underwent endoscopic balloon dilatation by a single operator. Of them, 14 had balloon dilatation twice and 6 had ballooning three times. The interval between the first referral and the last follow-up was 25.2 ± 10.3 (min: 4.8 max:43.4) months.

          The averages of maximum balloon size were 14.4 ± 5 mm in the first session, 14.3 ± 3.1mm in the second session, and 16 ± 2.4 mm in the third session. 73% of the patients had a significant improvement in clinical symptom with two sessions of EBD and did not require repeat dilatation.

          CONCLUSION

          EBD is a safe and efficient method in the management of GOO with good long term results.

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          Most cited references 24

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          Malignancy is the most common cause of gastric outlet obstruction in the era of H2 blockers.

          To determine the relative incidence of malignant and nonmalignant pathology in patients presenting with gastric outlet obstruction in the era of H2 blockers and to determine whether clinical features can differentiate between the two causes. The charts of 33 consecutive patients with gastric outlet obstruction admitted to one institution between July 1990 and November 1993 were reviewed to determine etiology, management, and outcome. The diagnosis of gastric outlet obstruction was based on clinical presentation, an upper gastrointestinal barium study, and/or an inability during upper endoscopy to intubate the second portion of the duodenum. Patients with gastroparesis or a previously known cancer were excluded. Sixty-one percent (20 patients) had malignancy as the cause of their gastric outlet obstruction. Thirty-nine percent (13 patients) had benign disease. The patients with cancer tended to be older, and fewer had a history of peptic ulcer disease, although these factors were not statistically significant. The use of nonsteroidal anti-inflammatory drugs was not associated with gastric outlet obstruction. Four patients had malignancy that had not been suspected before operation despite numerous endoscopic and radiological studies. The incidence of malignancy in patients presenting with gastric outlet obstruction is greater than 50%. The etiology of gastric outlet obstruction cannot be predicted by age, history of peptic ulcer disease, or nonsteroidal anti-inflammatory drug use. The endoscopic treatment of gastric outlet obstruction should be approached with caution because malignancy cannot be reliably excluded by endoscopic or radiological studies.
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            Endoscopic balloon dilation for benign gastric outlet obstruction in adults.

            Gastric outlet obstruction (GOO) includes obstruction in the antropyloric area or in the bulbar or post bulbar duodenal segments. Though malignancy remains the most common cause of GOO in adults, a significant number of patients have benign disease. The latter include peptic ulcer disease, caustic ingestion, post-operative anastomotic state and inflammatory causes like Crohn's disease and tuberculosis. Peptic ulcer remains the most common benign cause of GOO. Management of benign GOO revolves around confirmation of the etiology, removing the offending agent Helicobacter pylori (H. pylori), non-steroidal anti-inflammatory drugs, etc. and definitive therapy. Traditionally, surgery has been the standard mode of treatment for benign GOO. However, after the advent of through-the-scope balloon dilators, endoscopic balloon dilation (EBD) has emerged as an effective alternative to surgery in selected groups of patients. So far, this form of therapy has been shown to be effective in caustic-induced GOO with short segment cicatrization and ulcer related GOO. In the latter, EBD must be combined with eradication of H. pylori. Dilation is preferably done with wire-guided balloon catheters of incremental diameter with the aim to reach the end-point of 15 mm. While it is recommended that fluoroscopic control be used for EBD, this is not used by most endoscopists. Frequency of dilation has varied from once a week to once in three weeks. Complications are uncommon with perforation occurring more often with balloons larger than 15 mm. Attempts to augment efficacy of EBD include intralesional steroids and endoscopic incision.
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              The role of endoscopy in the management of patients with peptic ulcer disease.

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                Author and article information

                Journal
                Middle East J Dig Dis
                Middle East J Dig Dis
                MEJDD
                Middle East Journal of Digestive Diseases
                Iranian Association of Gastroerterology and Hepatology
                2008-5230
                2008-5249
                October 2019
                05 November 2019
                : 11
                : 4
                : 218-224
                Affiliations
                1Gastroenterology and Hepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
                2Department of Biostatistics, Shahre Kord University of Medical Sciences, Shahrekord, Islamic Republic of Iran
                3Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
                Author notes
                [* ] Corresponding Author: Kamran B. Lankarani, M.D Health Policy Research Center, Shiraz School of Medicine, Zand Blvd, Shiraz , IR Iran, Postal code: 7134845794 Telefax: + 98 71 32309615 Email: lankaran@ 123456sums.ac.ir
                Article
                10.15171/mejdd.2019.152
                6895853
                © 2019 The Author(s)

                This work is published by Middle East Journal of Digestive Diseaes as an open access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by-nc/4.0/). Non-commercial uses of the work are permitted, provided the original work is properly cited.

                Page count
                Figures: 3, Tables: 3, References: 24, Pages: 7
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