Kochhar Rakesh, Dutta Usha, Sethy Pradeepta K, Singh Gursewak, Sinha Saroj Kant, Nagi Birinder, Wig Jai Dev, Singh Kartar
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Gastrointest Endosc. 2009 Apr;69(4):800-5. doi: 10.1016/j.gie.2008.05.056. Epub 2009 Jan 10.
The standard treatment of caustic-induced gastric outlet obstruction (GOO) is surgery. There are only a few reports in the medical literature on endoscopic balloon dilation (EBD) for caustic-induced GOO.
To study the short-term and long-term response of EBD in patients with caustic-induced GOO.
Tertiary-care center in India.
Retrospective analysis of data.
Of the 49 patients with caustic-induced GOO seen by us between January 1998 and December 2003, 41 were treated by EBD. Thirty-seven patients had consumed an acid and 4 had consumed an alkali a mean (SD) of 19.5 +/- 14.5 weeks earlier. EBD was performed every 3 weeks by using through-the-scope balloons under endoscopic guidance.
The balloon was negotiated across the narrowed segment and inflated for 60 seconds by using a pressure gun. Balloons of incremental diameters, up to a maximum of 3 sizes, were used in each sitting. The end point of dilation was 15 mm, after which patients were assessed for recurrence. The patients were observed until August 2007.
All 41 patients (23 men; mean [SD] age 29.6 +/- 8.5 years) could be successfully taken for EBD. Thirty-nine patients underwent successful repeated dilations, which required a mean (SD) of 5.8 +/- 2.6 dilations (range 2-13) to achieve the end point of 15 mm. All 39 patients were followed up for an average (SD) of 35.4 +/- 11.1 months (range 18-58 months). The mean (SD) size of the first dilator was 8.2 +/- 0.6 mm (range 8-10 mm). One patient had a perforation and was subjected to antrectomy; another patient had pain every time he received EBD; he also had surgery. Other complications were minor: self-limiting pain (n = 8) or bleeding (n = 7).
EBD is a safe, effective, and long-lasting alternative to surgery for caustic-induced GOO.
腐蚀性所致胃出口梗阻（GOO）的标准治疗方法是手术。医学文献中关于内镜球囊扩张术（EBD）治疗腐蚀性所致GOO的报道较少。
研究EBD治疗腐蚀性所致GOO患者的短期和长期反应。
印度的三级医疗中心。
数据回顾性分析。
1998年1月至2003年12月期间我们诊治的49例腐蚀性所致GOO患者中，41例接受了EBD治疗。37例患者摄入了酸，4例患者摄入了碱，平均（标准差）为19.5±14.5周前。在内镜引导下，每3周使用经内镜球囊进行一次EBD。
将球囊通过狭窄段，使用压力枪充气60秒。每次操作使用直径逐渐增大的球囊，最多使用3种尺寸。扩张终点为15毫米，之后评估患者是否复发。对患者进行观察直至2007年8月。
所有41例患者（23例男性；平均[标准差]年龄29.6±8.5岁）均成功接受了EBD。39例患者成功进行了重复扩张，平均（标准差）需要5.8±2.6次扩张（范围2 - 13次）才能达到15毫米的终点。所有39例患者平均（标准差）随访35.4±11.1个月（范围18 - 58个月）。第一个扩张器的平均（标准差）尺寸为8.2±0.6毫米（范围8 - 10毫米）。1例患者发生穿孔，接受了胃窦切除术；另1例患者每次接受EBD时均疼痛，也接受了手术。其他并发症较轻：自限性疼痛（n = 8）或出血（n = 7）。
对于腐蚀性所致GOO，EBD是一种安全、有效且持久的手术替代方法。
