IDDF2021-ABS-0035 Opium addiction induced gastric outlet obstruction- an unusual entity

Abstract

<h3>Background</h3> There is a paucity of data in the literature on opium addiction causing gastric outlet obstruction. The aim was to study opium addiction causing gastric outlet obstruction and to assess the role of endotherapy. <h3>Methods</h3> Prospective study was conducted at SMS Hospital, Jaipur, between January 2017 to December 2020. All patients with a clinical diagnosis of gastric outlet obstruction with a history of opium addiction were consecutively enrolled. Data relating to demography, laboratory parameters, radiological imaging, histology and outcome of endotherapy were analyzed. <h3>Results</h3> Sixty patients (age 38.3±11.2years, BMI 17.6±2.9kg/m², 57 males) were studied. Site of involvement was pylorus with junction of first and second part of duodenum in 24(40%), junction of first and second part of duodenum in 16(26.7%), pylorus with distal second part or third part of duodenum in 11(18.3%) as shown in figure 1&amp;2 and pylorus, junction of first and second part of duodenum along with distal second part of duodenum or third part seen in 9(15%) patients (IDDF2021-ABS-0035 Figure 1. Endoscopic image showing ulcerated stricture at pylorus, IDDF2021-ABS-0035 Figure 2. Endoscopic image showing stricture in distal second part of duodenum). The mean number of opium-containing analgesic tablets per patient was 5.2±3.1 per day for duration of 33.1±25.8 months. Vomiting (96.1%), abdominal pain (93.5%) and weight loss (85.2%) were the most common presenting features. Forty-three (71.6%) patients improved with endotherapy along with strict opium abstinence as shown in figure 3 while 17 (28.3%) patients required surgical treatment (IDDF2021-ABS-0035 Figure 3. Endoscopic dilatation of pyloric stricture). <h3>Conclusions</h3> Opium addiction is also a cause of benign gastric outlet obstruction. Gut involvement is seen on multiple sites, with most common at the junction of the first and second part of the duodenum. A successful outcome of endotherapy is more likely in these patients.