ENDOSCOPIC FINDINGS IN HYPERTROPHIC PYLORIC-STENOSIS - APPEARANCE IN CLASSIC AND EVOLVING DISEASE

Background: Hypertrophic pyloric stenosis (HPS) is the most common abd ominal surgical disorder in infants. Although the majority of cases ar e diagnosed by ultrasound, equivocal cases may require endoscopy. This study was performed to assess the various endoscopic appearances of H PS in infants. Methods: A prospective study comparing the endoscopic a ppearance of the antrum and pylorus of 18 children with HPS to 21 chil dren in a normal control group.Results: Antral or pyloric mucosal hype rtrophy was visualized endoscopically in all 18 study patients; The de gree of mucosal thickening varied depending on the age of presentation and duration of symptoms. Antral fold hypertrophy was first noted at 10 days of age, and in the oldest patient (4 months of age) a pyloric mass was noted. By comparison, 21 control infants had no evidence of a ntral or pyloric narrowing or mucosal thickening. Conclusions: Upper e ndoscopy can be a valuable adjunctive diagnostic tool in select cases of HPS when imaging tests are inconclusive or when infants present wit h clinical symptoms outside the typical age-time frame for HPS. Becaus e HPS may evolve over time, it is important that the endoscopist recog nize the different appearances of HPS.