Endoscopy-guided balloon dilatation for infantile hypertrophic pyloric stenosis

Abstract

We first introduced endoscopy-guided balloon dilatation (EGBD) as a new method of nonoperative treatment for infantile hypertrophic pyloric stenosis (IHPS) in 1988. Up to now, we have treated 12 patients with this technique. The system used included an Olympus PQ 20 GIF endoscope, a balloon catheter with built-in-guide-wire, a pressure gauge, and a home-made inflationary device. The procedure was performed with the patients under general anaesthesia by an experienced paediatric endoscopist. Visualisation of the narrow pylorus was facilitated by a 180° clockwise rotation of the endoscope in the antrum. A 15-mm diameter balloon catheter was introduced after lubrication with silicone spray and inflated to 45 psi for 5–10 min. Of 12 patients, 11 had EGBD as primary treatment; of these, 4 responded completely and surgery was avoided, but 7 had an incomplete response requiring surgery. The remaining patient had EGBD as secondary treatment for an incomplete Ramstedt pyloromyotomy and responded satisfactorily. The longest follow-up after successful balloon dilatation was 22 months. Complete disappearance of the pyloric tumour was demonstrated by ultrasound examination 3 months after the procedure. Our experience confirms that balloon dilatation of IHPS is feasible, but at present its results are not consistent enough for recommendation of general use.