Pyloric balloon dilation for delayed gastric emptying in children

Delayed gastric emptying may manifest with symptoms of epigastric pain, ear ly satiety and delayed vomiting, and at times may be associated with failur e to thrive. These symptoms and signs may improve following surgical pyloro plasty. To determine whether pyloric balloon dilation (PBD) is an effective therapy for children with these symptoms, hospital records of all children who underwent endoscopic PBD between October 1991 and March 1994 at Britis h Columbia's Children's Hospital were reviewed. Excluded were children with chromosomal abnormalities, neurological disorders and erosive esophagitis. Through-the-scope balloons of diameter 15 or 18 mm were positioned in the pyloric channel and inflated with air to 2334 or 1815 mmHg respectively, fo r 2 min. Nineteen children with a mean age of 3.75 years (range eight month s to 10 years) who presented with symptoms for more than three months (mean 11 months) were identified. Eleven children presented with failure to thri ve, 14 with delayed vomiting and 10 with early satiety. Results of gastric emptying tests at 90 min ranged from 8% to 75% (mean 32%). The pylorus was difficult to intubate in I I of 19 children, and in two the pylorus could n ot be passed before PBD. No complications were experienced with PBD. Thirte en children had complete resolution of symptoms, and five had transient imp rovement lasting four to eight weeks after PBD with subsequent complete res olution of symptoms following surgical pyloroplasty. One child continued to have mild,symptoms after PBD but did not have further treatment. This stud y suggests that PBD is a safe and effective therapeutic option in children with symptoms and signs associated with delayed gastric emptying.