Balloon dilation of pyloric stenosis

Abstract

We read with interest the report on long-term outcome following balloon dilation of pyloric stenosis in the February issue.1Lau JYW Chung SCS Sung TY Chan ACW Ng EKW Suen RCV et al.Through-the-scope balloon dilation for pyloric stenosis: long-term results.Gastrointest Endosc. 1996; 43: 98-101Abstract Full Text Full Text PDF PubMed Scopus (77) Google Scholar In 41 patients, only 57.7% were free of recurrent obstruction or other ulcer complications at follow-up. More than half (51.2%) required subsequent surgery. These results are disappointing compared with other published reports, including the experience at our institution with 41 patients undergoing dilation therapy for benign, nonanastomotic gastric outlet obstruction. Successful outcome following dilation therapy, with minimal or no symptoms at mean follow-up of 20.4 months, occurred in 75.7% of patients. Only 5 patients (13.5%) underwent surgery.2Hemphill DJ Marcon NE Kortan P Kandel GP Siemens M Haber GB Predictors of success of endoscopic dilation of benign gastric outlet obstruction during long term follow-up [abstract].Gastrointest Endosc. 1995; 41: 364Abstract Full Text PDF Google Scholar Several procedural features may explain these varying results. In the series by Lau et al.1Lau JYW Chung SCS Sung TY Chan ACW Ng EKW Suen RCV et al.Through-the-scope balloon dilation for pyloric stenosis: long-term results.Gastrointest Endosc. 1996; 43: 98-101Abstract Full Text Full Text PDF PubMed Scopus (77) Google Scholar it is unclear what the initial goals of dilation therapy were. Although a balloon diameter of 15 mm was achieved in most patients, we are not told about other endoscopic or clinical features that suggest successful initial dilation. The majority of patients (80%) underwent a single dilation session only. Subsequent dilation sessions may have improved or consolidated the initial course of therapy. When patients presented with recurrent symptoms after an initial success it is not clear why they were not considered for repeat dilation. In our series, patients underwent a mean of 3.7 dilations each, with initial goals of therapy being symptom resolution, objective improvement in the stricture, and achievement of a high dilator diameter. Multiple dilations and achievement of a high maximum diameter of balloon (at least 18 mm) were procedural features associated with successful outcome. Patients who responded to an initial course of dilation therapy were dilated during early follow-up if symptoms recurred, and long-term follow-up of these patients indicates ongoing success of therapy, after completion of dilations. We are concerned about the recommendation by the authors that endoscopic balloon dilation therapy be reserved only for patients who are poor candidates for surgery. Excellent results can be obtained when endoscopists embark on a course of treatment involving multiple dilation sessions with progressive incremental increases in dilator diameter. It is our practice to consider through-the-scope balloon dilation therapy as first-line treatment for all patients with benign gastric outlet obstruction.