Endoscopic balloon dilatation is an effective management strategy for caustic-induced gastric outlet obstruction: a 15-year single center experience

Abstract

Background and study aims There is sparse data on the endoscopic management of caustic-induced gastric outlet obstruction (GOO). The present retrospective study aimed to define the response to endoscopic balloon dilatation (EBD) in such patients and their long-term outcome.

Patients and methods The data from symptomatic patients of caustic-induced GOO who underwent EBD at our tertiary care center between January 1999 and June 2014 were retrieved. EBD was performed using wire-guided balloons in an incremental manner. Procedural success and clinical success of EBD were evaluated, including complications and long-term outcome.

Results A total of 138 patients were evaluated of whom 111 underwent EBD (mean age: 30.79 ± 11.95 years; 65 male patients; 78 patients with isolated gastric stricture; 33 patients with both esophagus plus gastric stricture). The initial balloon diameter at the start of dilatation, and the last balloon diameter were 9.6 ± 2.06 mm (6 – 15 mm) and 14.5 ± 1.6 mm (6 – 15 mm), respectively. Procedural and clinical success was achieved in 95 (85.6 %) and 108 (97.3 %) patients, respectively, requiring a mean (SD) of 5.3 (2.6) and 7.21 (3.86) sessions, respectively. Patients with isolated gastric obstruction had a better response than those with combined esophagus and gastric stricture. Minor complications such as self-limited pain or bleeding were seen in 18 (16.2 %) and 16 (14.4 %), respectively. Perforation occurred in two patients. Over a follow-up period of 98 months, there were no recurrences.

Conclusion Caustic-induced GOO can be successfully managed using EBD with 97.3 % clinical success.

• References

• 1 Contini S, Scarpignato C. Caustic injury of the upper gastrointestinal tract: a comprehensive review. World J Gastroenterol 2013; 19: 3918-3930
• 2 Baskin D, Urganci N, Abbasoglu L. et al. A standardised protocol for the acute management of corrosive ingestion in children. Pediatr Surg Int 2004; 20: 824-828
• 3 Ciftci AO, Senocak ME, Buyukpamukcu N. et al. Gastric outlet obstruction due to corrosive ingestion: incidence and outcome. Pediatr Surg Int 1999; 15: 88-91
• 4 Kay M, Wyllie R. Caustic ingestions in children. Curr Opin Pediatr 2009; 21: 651-654
• 5 Zargar SA, Kochhar R, Mehta S. et al. The role of fiberoptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns. Gastrointest Endosc 1991; 37: 165-169
• 6 Gupta V, Wig JD, Kochhar R. et al. Surgical management of gastric cicatrisation resulting from corrosive ingestion. Int J Surg 2009; 7: 257-261
• 7 Ananthakrishnan N, Parthasarathy G, Kate V. Chronic corrosive injuries of the stomach – a single unit experience of 109 patients over thirty years. World J Surg 2010; 34: 758-764
• 8 Ray D, Chattopadhyay G. Surgical management of gastric outlet obstruction due to corrosive injury. Indian J Surg 2015; 77: 662-665
• 9 Tseng YL, Wu MH, Lin MY. et al. Early surgical correction for isolated gastric stricture following acid corrosion injury. Dig Surg 2002; 19: 276-280
• 10 Hsu CP, Chen CY, Hsu NY. et al. Surgical treatment and its long-term result for caustic-induced prepyloric obstruction. Eur J Surg 1997; 163: 275-279
• 11 Kozarek RA, Botoman VA, Patterson DJ. Long-term follow-up in patients who have undergone balloon dilation for gastric outlet obstruction. Gastrointest Endosc 1990; 36: 558-561
• 12 Hamzaoui L, Bouassida M, Ben MansourI. et al. Balloon dilatation in patients with gastric outlet obstruction related to peptic ulcer disease. Arab J Gastroenterol 2015; 16: 121-124
• 13 Cherian PT, Cherian S, Singh P. Long-term follow-up of patients with gastric outlet obstruction related to peptic ulcer disease treated with endoscopic balloon dilatation and drug therapy. Gastrointest Endosc 2007; 66: 491-497
• 14 Rana SS, Bhasin DK, Chandail VS. et al. Endoscopic balloon dilatation without fluoroscopy for treating gastric outlet obstruction because of benign etiologies. Surg Endosc 2011; 25: 1579-1584
• 15 Maharshi S, Puri AS, Sachdeva S. et al. Aetiological spectrum of benign gastric outlet obstruction in India: new trends. Trop Doct 2016; 46: 186-191
• 16 Kochhar R, Dutta U, Sethy PK. et al. Endoscopic balloon dilation in caustic-induced chronic gastric outlet obstruction. Gastrointest Endosc 2009; 69: 800-805
• 17 Kochhar R, Poornachandra KS, Dutta U. et al. Early endoscopic balloon dilation in caustic-induced gastric injury. Gastrointest Endosc 2010; 71: 737-744
• 18 Kochman ML, McClave SA, Boyce HW. The refractory and the recurrent esophageal stricture: a definition. Gastrointest Endosc 2005; 62: 474-475
• 19 Kochhar R, Ray JD, Sriram PV. et al. Intralesional steroids augment the effects of endoscopic dilation in corrosive esophageal strictures. Gastrointest Endosc 1999; 49: 509-513
• 20 Siddappa P, Reddy YR, Gupta P. et al. Application of a diathermic dilator for negotiating near-total antropyloric strictures. Endoscopy 2016; 48: E365-E366
• 21 Kochhar R, Samanta J, Basha J. et al. Biodegradable stents for caustic esophageal strictures: Do they work?. Dysphagia 2017; 32: 575-582
• 22 Chiu YC, Liang CM, Tam W. et al. The effects of endoscopic-guided balloon dilations in esophageal and gastric strictures caused by corrosive injuries. BMC Gastroenterol 2013; 13: 99
• 23 Solt J, Bajor J, Szabo M. et al. Long-term results of balloon catheter dilation for benign gastric outlet stenosis. Endoscopy 2003; 35: 490-495
• 24 Boylan JJ, Gradzka MI. Long-term results of endoscopic balloon dilatation for gastric outlet obstruction. Dig Dis Sci 1999; 44: 1883-1886
• 25 Kochhar R, Sriram PV, Ray JD. et al. Intralesional steroid injections for corrosive induced pyloric stenosis. Endoscopy 1998; 30: 734-736
• 26 Kochhar R, Makharia GK. Usefulness of intralesional triamcinolone in treatment of benign esophageal strictures. Gastrointest Endosc 2002; 56: 829-834
• 27 Hagiwara A, Sonoyama Y, Togawa T. et al. Combined use of electrosurgical incisions and balloon dilatation for the treatment of refractory postoperative pyloric stenosis. Gastrointest Endosc 2001; 53: 504-508
• 28 Boron B, Gross KR. Successful dilatation of pyloric stricture resistant to balloon dilatation with electrocautery using a sphinctertome. J Clin Gastroenterol 1996; 23: 239-241
• 29 Choi WJ, Park JJ, Park J. et al. Effects of the temporary placement of a self-expandable metallic stent in benign pyloric stenosis. Gut Liver 2013; 7: 417-422
• 30 Heo J, Jung MK. Safety and efficacy of a partially covered self-expandable metal stent in benign pyloric obstruction. World J Gastroenterol 2014; 20: 16721-16725
• 31 Lau JY, Chung SC, Sung JJ. et al. Through-the-scope balloon dilation for pyloric stenosis: long-term results. Gastrointest Endosc 1996; 43: 98-101
• 32 Lam YH, Lau JY, Fung TM. et al. Endoscopic balloon dilation for benign gastric outlet obstruction with or without Helicobacter pylori infection. Gastrointest Endosc 2004; 60: 229-233