ENDOSCOPIC PYLORIC BALLOON DILATION FOR NONPEPTIC, NONHYPERTROPHIC PYLORIC STENOSIS IN A YOUNG INFANT

Abstract

Background: Non-peptic, non-hypertrophic pyloric stenosis was rarely reported in pediatric literature. Endoscopic pyloric balloon dilation (EPBD) has been shown to be a safe procedure in treating gastric outlet obstruction in older children and adults. Methods: We recently cared for a formerly healthy 18-month-old male infant with a history of partial gastric outlet obstruction (GOO). EPBD was performed with an endoscope (Pentax-EG-2731) and catheter balloons (Boston Scientific Microvasive, MA, USA). Results: Partial GOO was diagnosed by ~ 3-week history of non-bilious vomiting and confirmed by an upper gastrointestinal series (UGI). He had iron deficency anemia but no history of gross or occult GI bleeding. The patient had been exclusively breastfed until 1 year of age. Abdominal ultrasonography and CT scan excluded idiopathic hypertrophic pyloric stenosis, abdominal tumors, GI and hepato-biliary-pancreatic anomalies. Endoscopic and pathology findings showed a pinhole-sized pylorus without evidence of peptic ulcer disease, Helicobacter pylori infection, antral web, or allergic and inflammatory bowel diseases. The DHR assay showed a normal granulocytic oxidative burst. Three sessions of step-wise EPBD were conducted under general anesthesia and a fluoroscopy at two weeks apart. Catheter balloons of increasing diameters (first session at 6 mm and 8 mm, second session at 10 mm and 12.5 mm, and third session at 15mm) were used to insert through the biopsy channel of the endoscope and inflated with the use of a pressure gauge system for 60-120 seconds. The patient tolerated solid food without any GI symptoms from the first session. The endoscope was able to be passed through the pylorus after the last session. Duodenal mucosa looked normal. Repeat UGI and gastric emptying scan revealed no GI obstruction and normal GI transit for age. Conclusions: The etiology of pyloric stenosis in this infant is unknown. EPBD was a safe procedure for treating this condition and is recommended as an initial approach before pyloroplasty.