RESULTS OF ENDOSCOPIC BALLOON DILATATION IN PATIENTS WITH GASTRIC OUTLET OBSTRUCTION RELATED TO PEPTIC ULCER DISEASE

Aims:

Pyloric and bulbar stenosis is a rare complication of peptic ulcer disease (PUD). Surgery has been the conventional treatment, but it is associated with significant morbidity. Endoscopic balloon dilatation (EBD) with medical treatment showed short- and long-term efficacy and safety. The aim of our study was to evaluate the results of the EBD in patients with Pyloric and bulbar stenosis related to PUD and to determine the predictive factors of poor response to EBD.

Methods:

We conducted a retrospective descriptive study, including all patients who underwent an EBD for pyloric and bulbar stenosis related to PUD, between January 1997 and january 2017. the stenosis was defined by the inability to pass a 12-mm-diameter endoscope beyond the obstruction. The patients received a double-dose proton-pump inhibitor intravenously for 7 – 10 days and underwent a control endoscopic examination. If the obstruction persisted, an EBD was performed.

Results:

Seventy three patients were included with a mean age of 51 years old (20 – 81). The sex ratio was 5,6. Seventy percent of patients were smokers and 7% were taking non steroidalanti-inflammatory drugs. Thirty four patients had a history of PUD. All patients were suffering from abdominal pain and vomiting. The median number of EBD sessions per patient was 1,67 (1 – 4). The median diameter of the balloon was 16 mm (12 – 20 mm). A duodenal perforation occured in one cas. The EBD was successful in 72,6% of case. A surgical treatment was necessary on 20 patients.

Predictive factors for an unsuccessful EBD were: the failure of HP eradication, a number of sessions> 3 with p respectively, 0.03 and 0.045.

Conclusions:

The EBD associated with HP eradication is an effective and save treatment of pyloric and bulbar stenosis related to PUD.