Balloon dilatation in patients with gastric outlet obstruction related to peptic ulcer disease

Abstract

Background and study aimsGastric outlet obstruction (GOO) is a rare complication of peptic ulcer disease (PUD). The endoscopic balloon dilatation (EBD) associated with medical treatment of Helicobacter pylori is a successful method in the management of pyloric stenosis. The aim of this study was to describe epidemiological, clinical, and endoscopic characteristics of GOO related to PUD and to evaluate the effectiveness, safety, and outcome of EBD. Patients and methodsIn a retrospective study of patients seen between 1999 and 2009 with symptoms of GOO secondary to PUD, pyloro-bulbar stenosis was confirmed by endoscopic examination. Balloon dilatation was performed when obstruction persisted after treatment with double-dose proton-pump inhibitor (PPI) intravenously for 7–10days. The H. pylori status was assessed with histology, and eradication therapy was prescribed for infection. ResultsA total of 45 consecutive patients (38 males, 7 females median age, 51.9years; range, 20–58years) with symptoms of GOO secondary to PUD underwent EBD.Median follow-up time of the 45 patients was 32months (range, 4–126months). The immediate success rate of the procedure was 95.5%. Clinical remission was noted in 84.4% of the patients. Remission without relapse was observed in 55.8%, 30months after the dilatation. Pyloric stenosis relapsed in 15 patients (39.5%) after a median period of 22.9months. The dilatation was complicated in three patients (6.7%, two perforations and one bleeding). A total of 13 patients (29%) underwent surgery. H. pylori was found to be positive in 97.7% of the patients, and was eradicated in 78.4% of them. Smoking and failure of H. pylori eradication were associated with the relapse of the stenosis. ConclusionEBD is a simple, effective, and safe therapy for the GOO related to PUD, producing short- and long-term remission.