Successful management of membranous duodenal stenosis by endoscopic balloon dilation and membrane resection with an insulated-tip knife

Wang, Xing; Liu, Haifeng; Ye, Guogang; Lv, Zhibao; Hu, Zhihong

doi:10.1055/a-1506-2785

Cited by 4 publications

(4 citation statements)

References 4 publications

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“…In our study, there are 8 children whose Vater papilla could not be identified directly by gastroscopy, except for 5 cases were below the membrane, the rest were just located in or closely next to the membrane. As for them, we first used a balloon of appropriate size for fully effective dilation so that the narrow openings were enlarged for passage of an endoscope, then accompanied by right middle abdominal compression; generally, the Vater papilla could be identified on inner side of the duodenal lumen with bile or bubbles flowing out (18). For excision of the membrane, we chose 6 months as the boundary to select different approaches, considering that children under 6 months old were mainly fed with breast milk or formula, whereas for children more than 6 months, membrane might be thickened and expanded passively with the addition of complementary foods.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Balloon Dilatation-Based Membrane Resection for Membranous Duodenal Stenosis: A Feasibility and Safety Study (With Video)

Wang

Lin

Liu

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: Surgery is generally considered as the first-line therapy for membranous duodenal stenosis (MDS) in children. However, abdominal surgery leaves permanent scars and may even cause intestinal adhesion. Therefore, an effective, safe, and minimally invasive method is urgently needed. This study aimed to evaluate the safety, efficacy, and feasibility of endoscopic balloon dilatation-based membrane resection (EBD-MR) to treat MDS in children. Methods: We retrospectively reviewed patients with MDS treated with EBD-MR in Shanghai Children’s Hospital from May 2016 to August 2021. Primary study outcome was clinical success, defined as weight gain and complete remission of vomiting, without the need for repeat endoscopic or surgical intervention during follow-up. Secondary outcomes included technical success, diameter changes of the membrane opening, and adverse events. Results: Nineteen children (9 females, mean age 14.5 ± 11.2 months) received endoscopic treatment for MDS, and clinical success was achieved in 18 of 19 patients (94.7%). No bleeding, perforation, and jaundice occurred. Diameters of the membrane opening increased from 2.97 ± 2.87 mm to 9.78 ± 1.27 mm after the treatment, symptoms of vomiting did not reappear during 10–73 months of follow-up, and body mass index of the children increased from 14.9 ± 2.2 kg/m2 (pre-operation) to 16.2 ± 3.7 kg/m2 (6 months after operation). One patient required surgical revision because of existence of a second web; three patients received 2–3 sessions of endoscopic treatment to obtain the final remission. Conclusions: The EBD-MR technique is safe, effective, and feasible for MDS, which provided an excellent alternative to surgical management for the disease in pediatric patients.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Balloon Dilatation-Based Membrane Resection for Membranous Duodenal Stenosis: A Feasibility and Safety Study (With Video)

Wang

Lin

Liu

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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“…Reports of endoluminal therapy for duodenal lesions in pediatric patients are growing and appear effective in the hands of experienced advanced endoscopists (2–9). Goring et al reported a 2‐center case series of 15 pediatric patients (7).…”

Section: Discussionmentioning

confidence: 99%

“…Surgical intervention increases the patient's risk of surgical complications, including wound infection, anastomotic leakage, hepatobiliary injury, intestinal adhesions, and ventral hernias (1). With the recent advancement of endoscopic therapy, including balloon dilation and endoscopic incisional therapy (EIT), advanced endoscopists can offer endoluminal treatment for duodenal anomalies in children with reduced recovery time (2) while avoiding potential postsurgical complications (1)(2)(3)(4)(5)(6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Avoiding Surgery: Endoscopic Treatment of Congenital Duodenal Stenosis

Baran,

Brown,

Rivera-Nieves

et al. 2023

JPGN Reports

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Duodenal stenosis is a rare congenital anomaly that is typically treated surgically, although endoscopic incisional therapy (EIT) and balloon dilation are minimally invasive alternatives. We present a case of a 15-month-old male with vomiting and difficulty tolerating solid food due to severe congenital duodenal stenosis. The patient underwent EIT and serial duodenal dilation to a diameter of 20 mm, which resulted in significant symptom improvement. Intralesional corticosteroid injection (ISI) was administered to help prevent the duodenal septum from restricturing. The combination of EIT, balloon dilation, and ISI was successful in treating the patient’s congenital duodenal stenosis and avoided the need for surgery. However, further studies are required to confirm the efficacy of this treatment approach in this patient population. This report highlights the potential of this minimally invasive approach as an alternative to surgical intervention in the management of congenital duodenal stenosis.

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“…Congenital duodenal membranous stenosis (DMS) is a narrowing of the lumen caused by formation by the mucosa of membrane-like structures; it is a rare disease with a frequency of 1 in 10.000–40.000 1 . Notably, some endoscopic treatments for congenital DMS have been reported 1 2 3 4 ; however, the endoscope’s maneuverability in pediatric patients’ duodenums is limited because of their small physique. Herein, we present a case of congenital DMS in which a scissors-type knife was successfully used to treat the membranous stenosis.…”

Section: Figmentioning

confidence: 99%

Endoscopic membrane resection using a scissors-type knife in a pediatric patient with congenital duodenal membranous stenosis

Nakamura,

Hikichi,

Tanaka

et al. 2024

Endoscopy

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Successful management of membranous duodenal stenosis by endoscopic balloon dilation and membrane resection with an insulated-tip knife

Cited by 4 publications

References 4 publications

Endoscopic Balloon Dilatation-Based Membrane Resection for Membranous Duodenal Stenosis: A Feasibility and Safety Study (With Video)

Endoscopic Balloon Dilatation-Based Membrane Resection for Membranous Duodenal Stenosis: A Feasibility and Safety Study (With Video)

Avoiding Surgery: Endoscopic Treatment of Congenital Duodenal Stenosis

Endoscopic membrane resection using a scissors-type knife in a pediatric patient with congenital duodenal membranous stenosis

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