7095 Description of endoscopic stricturotomy and pyloric myotomy in patients with mechanical gastric outlet obstruction.

Abstract

INTRODUCTION Gastric outlet obstruction (GOO) is a recognized complication of peptic ulcer disease (PUD) and initially will provoke treatment with endoscopic balloon therapy that often requires repeat procedures. Ultimately open surgical procedures are necessary. This study was designed to judge the efficacy of endoscopic incision in managing GOO. METHOD 3 patients (2 female and 1 male) presented with GOO. All patients had an EGD to confirm presence of a mechanical lesion. All strictures or deformities were first dilated with a Microvasive TTS Balloon to determine levels of weakness within the obstructed area. Standard endoscopic incision was then employed with the Microvasive biopsy forceps until the lumen was fully patent and the muscular layer was reached. Endoscopic incision with a Microvasive sphincterotome was utilized in one of the 3 cases. RESULTS The first patient was an 86y.o. female who had undergone 4 previous dilations of a stenotic pylorus due to prior PUD. She was scheduled for a pyloroplasty. At EGD she was determined to have a 1cm thick stricture extending into the bulb. Balloon dilation followed by biopsy forceps incision carried to the muscular layer increased the luminal diameter from 3mm to 13mm. Slight hemorrhage stopped promptly with injection of HSE. Second patient was an 85yo male with recent duodenal ulcer causing a pyloric stricture that resulted in a 2-3mm opening. The angulation of the bulb prohibited pre-incisional use of a TTS balloon. Again incision to the muscularus was employed extending the pyloric channel to 12mm. The 3rd patient was an 80yo female with prepyloric ring causing obstruction that failed both balloon distention and forceps incision. It was effectively destroyed by incision using a sphincterotome. Avg. follow-up time was 11.3 months and no recurrences have been observed. CONCLUSIONS #1 Endoscopic stricturotomy and pyloric myotomy allows a safe and effective alternative to open procedures for patients with GOO #2 Results appear long-lasting #3 Recovery time is the same as regular endoscopy