Shah Jimil, Reddy Yalaka Rami, Gupta Pankaj, Samanta Jayanta, Kumar Naveen, Sinha Saroj K, Kochhar Rakesh
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India.
GE Radiology, Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India.
Indian J Gastroenterol. 2022 Apr;41(2):190-197. doi: 10.1007/s12664-021-01208-1. Epub 2022 Feb 21.
Caustic-induced gastric outlet obstruction (GOO) remains one of the important causes of long-term morbidity in patients with caustic ingestion. Though endoscopic balloon dilation is an effective modality, response to caustic GOO is poorer as compared to peptic stricture. Computed tomography (CT)-antral wall thickness (AWT) has not been previously explored to predict the procedural success in patients with caustic GOO.
In a retrospective single-center study of prospectively maintained database, all patients with symptomatic caustic GOO who underwent CT scan prior to endoscopic balloon dilation were included. Gastric AWT was measured at the site of maximum visible thickness on CT scan. Details regarding caustic ingestion and endoscopic dilation were retrieved. Patients were divided into two groups, based on CT-AWT (< or ≥9 mm) and compared for outcome measures.
Mean age of included patients (n=35) was 33.51 ± 13.65 years and 22 were male. Procedural success was achieved in 29 (82.85%) patients. Number of mean dilation sessions required were 5.28 ± 2.96 for achieving procedural success. The mean CT-AWT was 10.73 ± 2.80 mm (range 4-18 mm). There was no significant association between the CT-AWT and the number of dilations and procedural success. On univariate analysis, size of the first balloon used was a predictor of refractory stricture (p=0.011). However, no other factors predicted either refractory stricture or procedural success.
There is no additional role of CT-AWT in predicting response to endoscopic balloon dilation or to predict refractory stricture in patients with caustic GOO.
腐蚀性物质所致胃出口梗阻（GOO）仍是腐蚀性物质摄入患者长期发病的重要原因之一。尽管内镜球囊扩张是一种有效的治疗方式，但与消化性狭窄相比，腐蚀性GOO的治疗反应较差。此前尚未探索计算机断层扫描（CT）测量的胃窦壁厚度（AWT）能否预测腐蚀性GOO患者的治疗成功率。
在一项对前瞻性维护数据库的回顾性单中心研究中，纳入了所有在内镜球囊扩张术前接受CT扫描的有症状腐蚀性GOO患者。在CT扫描上可见厚度最大的部位测量胃AWT。检索有关腐蚀性物质摄入和内镜扩张的详细信息。根据CT-AWT（<或≥9 mm）将患者分为两组，并比较其治疗结局指标。
纳入患者（n = 35）的平均年龄为33.51±13.65岁，男性22例。29例（82.85%）患者治疗成功。为达到治疗成功平均所需的扩张次数为5.28±2.96次。平均CT-AWT为10.73±2.80 mm（范围4 - 18 mm）。CT-AWT与扩张次数和治疗成功率之间无显著相关性。单因素分析显示，首次使用的球囊大小是难治性狭窄的预测因素（p = 0.011）。然而，没有其他因素可预测难治性狭窄或治疗成功率。
CT-AWT在预测腐蚀性GOO患者内镜球囊扩张的反应或难治性狭窄方面没有额外作用。
