Endoscopic balloon dilation management for benign duodenal stenosis.

Autor: Chittajallu V; Digestive Health Institute, University Hospitals Cleveland, Cleveland, OH, USA. vibhu.chittajallu@uhhospitals.org., Omar YA; Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA., Simons-Linares CR; Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA., Chahal P; Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2023 May; Vol. 37 (5), pp. 3610-3618. Date of Electronic Publication: 2023 Jan 09.
DOI: 10.1007/s00464-022-09844-0
Abstrakt: Background and Aims: Benign duodenal stenosis (BDS) is most commonly caused by peptic ulcer disease (PUD). Endoscopic balloon dilation (EBD) is the recommended initial management despite limited supporting literature. Our study investigated the etiologic spectrum of BDS and its response to endoscopic dilation.
Methods: We performed a cohort study of a prospectively maintained database of BDS at our large tertiary academic center between 2002 and 2018. All patients who underwent EBD were analyzed. Dilation was performed using through-the-scope balloons. Technical and clinical successes of initial and repeat EBD were compared. Descriptive statistics, univariate, and multivariate analysis were performed.
Results: The study included 86 patients with 54.7% female gender. Etiologies included 39 patients with PUD (45.3%), 19 patients with Crohn's disease (22.1%), 23 patients had idiopathic etiologies (26.7%), and 5 patients were listed as other etiologies (5.8%). Proximal stricture location (1st part of duodenum) occurred in 66% of females, whereas distal duodenal involvement was seen in 63.6% of males (p value 0.007). Usage of PPI was associated with 3.6 times higher clinical success rate (p value 0.04). Technical (97.4%) and clinical (77.8%) successes for index dilations in PUD were not significantly better than those of non-PUD patients (p values 0.99, 0.52).
Conclusion: EBD has both a high technical and clinical success for BDS regardless of etiology and should be considered over initial surgical intervention due to low risk profile. Males tend to have more distal duodenal involvement, and PPI usage is an independent predictor for clinical success.
(© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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