Endoscopic balloon dilatation of peptic pyloroduodenal strictures

A through-the-scope endoscopic balloon dilatation technique and acid-reduci ng medication was used in 46 consecutive patients (median age, 55; range, 2 1-88 years) with benign gastric outlet obstruction. In five patients, dilat ation was not technically possible. In 41 patients, 122 dilatations (median , 2; range, 1-9 per patient) were performed without morbidity. Ninety-four procedures were successful (77%) at the initial attempt table to pass a 12- mm endoscope into the duodenum at the end of the procedure). Median follow- up in the 41 patients was 19 (range, 1-78) months. Thirteen patients (32%) required subsequent surgery; 8 had delayed operation for persistent symptom s (1-28 months after the first dilatation), I had surgery during the initia l hospital admission, and 4 required emergency surgery for other nicer comp lications (3 perforation, 1 bleeding). Of the 28 patients who had only ball oon dilatation and medical therapy, 11 are asymptomatic (4 with active ulce ration), 9 have mild symptoms (Visick 2)1 and 3 have persistent symptoms (V isick 3). One patient was lost to follow-up and four patients have died ton e from an ulcer-related complication). Balloon dilatation and sustained aci d-reducing therapy with regular endoscopic surveillance should be first-lin e treatment of peptic pyloroduodenal strictures, because the procedure is s afe and is likely to be successful in half of the patients in whom dilatati on is technically possible.