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Endoscopic balloon dilation management for benign duodenal stenosis

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Abstract

Background and aims

Benign duodenal stenosis (BDS) is most commonly caused by peptic ulcer disease (PUD). Endoscopic balloon dilation (EBD) is the recommended initial management despite limited supporting literature. Our study investigated the etiologic spectrum of BDS and its response to endoscopic dilation.

Methods

We performed a cohort study of a prospectively maintained database of BDS at our large tertiary academic center between 2002 and 2018. All patients who underwent EBD were analyzed. Dilation was performed using through-the-scope balloons. Technical and clinical successes of initial and repeat EBD were compared. Descriptive statistics, univariate, and multivariate analysis were performed.

Results

The study included 86 patients with 54.7% female gender. Etiologies included 39 patients with PUD (45.3%), 19 patients with Crohn’s disease (22.1%), 23 patients had idiopathic etiologies (26.7%), and 5 patients were listed as other etiologies (5.8%). Proximal stricture location (1st part of duodenum) occurred in 66% of females, whereas distal duodenal involvement was seen in 63.6% of males (p value 0.007). Usage of PPI was associated with 3.6 times higher clinical success rate (p value 0.04). Technical (97.4%) and clinical (77.8%) successes for index dilations in PUD were not significantly better than those of non-PUD patients (p values 0.99, 0.52).

Conclusion

EBD has both a high technical and clinical success for BDS regardless of etiology and should be considered over initial surgical intervention due to low risk profile. Males tend to have more distal duodenal involvement, and PPI usage is an independent predictor for clinical success.

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References

  1. Sigmon DF, Eovaldi BJ, Cohen HL (2022) Duodenal atresia and stenosis. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470548/. Accessed 29 Aug 2022

  2. Kochhar R, Kochhar S (2010) Endoscopic balloon dilation for benign gastric outlet obstruction in adults. World J Gastrointest Endosc 2(1):29–35

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bruno MJ, Maluf-Filho F (2019) Palliation of malignant pancreaticobiliary obstruction. In: Chandrasekhar V et al (eds) Clinical gastrointestinal endoscopy, 3rd edn. Elsevier, Philadelphia, PA, pp 734–747

  4. Mangiavillano B, Khashab MA, Tarantino I et al (2019) Success and safety of endoscopic treatments for concomitant biliary and duodenal malignant stenosis: A review of the literature. World J Gastrointest Surg 11(2):53–61

    Article  PubMed  PubMed Central  Google Scholar 

  5. Shone DN, Nikoomanesh P, Smith-Meek MM, Bender JS (1995) Malignancy is the most common cause of gastric outlet obstruction in the era of H2 blockers. Am J Gastroenterol 90(10):1769–1770

    CAS  PubMed  Google Scholar 

  6. Kozoll DD, Meyer KA (1964) Obsturcting Gastroduodenal Ulcer. Symptoms and Signs Arch Surg 89:491–498

    Article  CAS  PubMed  Google Scholar 

  7. Jaffin BW, Kaye MD (1985) The prognosis of gastric outlet obstruction. Ann Surg 201(2):176–179

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Weiland D, Dunn DH, Humphrey EW, Schwartz ML (1982) Gastric outlet obstruction in peptic ulcer disease: an indication for surgery. Am J Surg 143:90–93

    Article  CAS  PubMed  Google Scholar 

  9. Chaudhary A, Puri AS, Dhar P, Reddy P, Sachdev A, Lahoti D, Kumar N, Broor SL (1996) Elective surgery for corrosive induced gastric injury. World J Surg 20:703–706; discussion 706

  10. Yusuf TE, Brugge WR (2006) Endoscopic therapy of benign pyloric stenosis and gastric outlet obstruction. Curr Opin Gastroenterol 22:570–573

    Article  PubMed  Google Scholar 

  11. Cherian PT, Cherian S, Singh P (2007) 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 66(3):491–497

    Article  PubMed  Google Scholar 

  12. Kochhar R, Sethy PK, Nagi B et al (2004) Endoscopic balloon dilatation of benign gastric outlet obstruction. J Gastroenterol Hepatol 19:418–422

    Article  PubMed  Google Scholar 

  13. Hamzaoui L, Bouassida M, Ben Mansour I et al (2015) Balloon dilatation in patients with gastric outlet obstruction related to peptic ulcer disease. Arab J Gastroenterol 16(3–4):121–124

    Article  PubMed  Google Scholar 

  14. Kochhar R, Malik S, Gupta P et al (2018) Etiological spectrum and response to endoscopic balloon dilation in patients with benign gastric outlet obstruction. Gastrointest Endosc 88(6):899–908

    Article  PubMed  Google Scholar 

  15. Rana SS, Bhasin DK, Chandail VS et al (2011) Endoscopic balloon dilatation without fluoroscopy for treating gastric outlet obstruction because of benign etiologies. Surg Endosc 25:1579–1584

    Article  PubMed  Google Scholar 

  16. Maharshi S, Puri AS, Sachdeva S et al (2016) Aetiological spectrum of benign gastric outlet obstruction in India: new trends. Trop Doct 46:186–191

    Article  PubMed  Google Scholar 

  17. Fallone CA, Chiba N, van Zanten SV et al (2016) The Toronto Consensus for the Treatment of Helicobacter pylori Infection in Adults. Gastroenterology 151(1):51–69

    Article  PubMed  Google Scholar 

  18. Boylan JJ, Gradzka MI (1999) Long-term results of endoscopic balloon dilatation for gastric outlet obstruction. Dig Dis Sci 44:1883–1886

    Article  CAS  PubMed  Google Scholar 

  19. Solt J, Bajor J, Szabo M et al (2003) Long-term results of balloon catheter dilation for benign gastric outlet stenosis. Endoscopy 35:490–495

    Article  CAS  PubMed  Google Scholar 

  20. Feldman M, Friedman LS, Brandt LJ (2016) Sleisenger and Fordtran’s gastrointestinal and liver disease: pathophysiology/diagnosis/management, vol 2, 10th edn. Saunders/Elsevier, Philadelphia, PA (p xxxi, 2369, 2389)

  21. Fortun PJ, Hawkey CJ (2007) Nonsteroidal antiinflammatory drugs and the small intestine. Curr Opin Gastroenterol 23(2):134–141

    CAS  PubMed  Google Scholar 

  22. Gajendran M, Loganathan P, Catinella AP, Hashash JG (2018) A comprehensive review and update on Crohn’s disease. Dis Mon 64(2):20–57

    Article  PubMed  Google Scholar 

  23. Bessissow T, Reinglas J, Aruljothy A, Lakatos PL, Van Assche G (2018) Endoscopic management of Crohn’s strictures. World J Gastroenterol 24(17):1859–1867

    Article  PubMed  PubMed Central  Google Scholar 

  24. Williams AJ, Palmer KR (1991) Endoscopic balloon dilatation as a therapeutic option in the management of intestinal strictures resulting from Crohn’s disease. Br J Surg 78(4):453–454

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Digestive Health Institute, University Hospitals Cleveland, Cleveland, OH, USA

    Vibhu Chittajallu

  2. Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA

    Yazan Abu Omar

  3. Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA

    C. Roberto Simons-Linares & Prabhleen Chahal

Authors
  1. Vibhu Chittajallu
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  2. Yazan Abu Omar
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  3. C. Roberto Simons-Linares
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  4. Prabhleen Chahal
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Contributions

VC participated in conception and design, analysis and interpretation of data, drafting of the article, critical revision of the article for important intellectual content; YAO participated in analysis and interpretation of the data; CRSL participated in conception and design, analysis and interpretation of the data, and final approval of the article; PC participated in conception and design and final approval of the article.

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Correspondence to Vibhu Chittajallu.

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Drs. Vibhu Chittajallu, Yazan Abu Omar, C. Roberto Simons-Linares, and Prabhleen Chahal have no conflicts of interest or financial ties to disclose.

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Chittajallu, V., Omar, Y.A., Simons-Linares, C.R. et al. Endoscopic balloon dilation management for benign duodenal stenosis. Surg Endosc 37, 3610–3618 (2023). https://doi.org/10.1007/s00464-022-09844-0

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  • DOI: https://doi.org/10.1007/s00464-022-09844-0

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