Hamzaoui Lamine, Bouassida Mahdi, Ben Mansour Imed, Medhioub Mouna, Ezzine Heykal, Touinsi Hassen, Azouz Mohamed M
Gastroenterology Department, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.
General Surgery Department, Mohamed Tahar Maamouri Hospital, Nabeul, Tunisia.
Arab J Gastroenterol. 2015 Sep-Dec;16(3-4):121-4. doi: 10.1016/j.ajg.2015.07.004. Epub 2015 Oct 3.
Gastric outlet obstruction (GOO) is a rare complication of peptic ulcer disease (PUD). The endoscopic balloon dilatation (EBD) associated with medical treatment of Helicobacter pylori is a successful method in the management of pyloric stenosis. The aim of this study was to describe epidemiological, clinical, and endoscopic characteristics of GOO related to PUD and to evaluate the effectiveness, safety, and outcome of EBD.
In a retrospective study of patients seen between 1999 and 2009 with symptoms of GOO secondary to PUD, pyloro-bulbar stenosis was confirmed by endoscopic examination. Balloon dilatation was performed when obstruction persisted after treatment with double-dose proton-pump inhibitor (PPI) intravenously for 7-10days. The H. pylori status was assessed with histology, and eradication therapy was prescribed for infection.
A total of 45 consecutive patients (38 males, 7 females median age, 51.9years; range, 20-58years) with symptoms of GOO secondary to PUD underwent EBD. Median follow-up time of the 45 patients was 32months (range, 4-126months). The immediate success rate of the procedure was 95.5%. Clinical remission was noted in 84.4% of the patients. Remission without relapse was observed in 55.8%, 30months after the dilatation. Pyloric stenosis relapsed in 15 patients (39.5%) after a median period of 22.9months. The dilatation was complicated in three patients (6.7%, two perforations and one bleeding). A total of 13 patients (29%) underwent surgery. H. pylori was found to be positive in 97.7% of the patients, and was eradicated in 78.4% of them. Smoking and failure of H. pylori eradication were associated with the relapse of the stenosis.
EBD is a simple, effective, and safe therapy for the GOO related to PUD, producing short- and long-term remission.
胃出口梗阻（GOO）是消化性溃疡病（PUD）的一种罕见并发症。内镜下球囊扩张术（EBD）联合幽门螺杆菌的药物治疗是治疗幽门狭窄的一种成功方法。本研究的目的是描述与PUD相关的GOO的流行病学、临床和内镜特征，并评估EBD的有效性、安全性和结局。
在一项对1999年至2009年间因PUD继发GOO症状就诊患者的回顾性研究中，通过内镜检查确诊为幽门-球部狭窄。在静脉注射双倍剂量质子泵抑制剂（PPI）治疗7 - 10天后梗阻仍持续存在时进行球囊扩张。通过组织学评估幽门螺杆菌状态，并对感染患者进行根除治疗。
共有45例因PUD继发GOO症状的连续患者（38例男性，7例女性，中位年龄51.9岁；范围20 - 58岁）接受了EBD。45例患者的中位随访时间为32个月（范围4 - 126个月）。该操作的即时成功率为95.5%。84.4%的患者出现临床缓解。扩张后30个月，55.8%的患者缓解且无复发。15例患者（39.5%）在中位时间22.9个月后幽门狭窄复发。3例患者（6.7%，2例穿孔和1例出血）出现扩张并发症。共有13例患者（29%）接受了手术。97.7%的患者幽门螺杆菌检测呈阳性，其中78.4%的患者幽门螺杆菌被根除。吸烟和幽门螺杆菌根除失败与狭窄复发有关。
EBD是一种治疗与PUD相关的GOO的简单、有效且安全的疗法，可产生短期和长期缓解。
