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.