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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Oct 16, 2016; 8(18): 635-645
Published online Oct 16, 2016. doi: 10.4253/wjge.v8.i18.635
Update on endoscopic management of gastric outlet obstruction in children
Hsun-Chin Chao
Hsun-Chin Chao, Division of Gastroenterology, Department of Pediatrics, Chang Gung Children’s Hospital, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
Author contributions: Chao HC contributed to the manuscript.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hsun-Chin Chao, MD, Associate Professor, Division of Gastroenterology, Department of Pediatrics, Chang Gung Children’s Hospital, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Gueishan District, Taoyuan City 33305, Taiwan. chaohero@yahoo.com
Telephone: +886-3-3281200 Fax: +886-3-3288957
Received: March 27, 2016
Peer-review started: March 28, 2016
First decision: May 23, 2016
Revised: June 18, 2016
Accepted: August 6, 2016
Article in press: August 8, 2016
Published online: October 16, 2016
Processing time: 199 Days and 21 Hours
Abstract

Endoscopic balloon dilatation (EBD) and surgical intervention are two most common and effective treatments for gastric outlet obstruction. Correction of gastric outlet obstruction without the need for surgery is an issue that has been tried to be resolved in these decades; this management has developed with EBD, advanced treatments like local steroid injection, electrocauterization, and stent have been added recently. The most common causes of pediatric gastric outlet obstruction are idiopathic hypertrophic pyloric stenosis, peptic ulcer disease followed by the ingestion of caustic substances, stenosis secondary to surgical anastomosis; antral web, duplication cyst, ectopic pancreas, and other rare conditions. A complete clinical, radiological and endoscopic evaluation of the patient is required to make the diagnosis, with complimentary histopathologic studies. EBD are used in exceptional cases, some with advantages over surgical intervention depending on each patient in particular and on the characteristics and etiology of the gastric outlet obstruction. Local steroid injection and electrocauterization can augment the effect of EBD. The future of endoscopic treatment seems to be aimed at the use of endoscopic electrocauterization and balloon dilatations.

Keywords: Gastric outlet obstruction; Endoscopic balloon dilatation; Electrocauterization; Steroid injection; Children

Core tip: Correction of gastric outlet obstruction without the need for surgery is an issue that has been tried to be resolved in these decades; this management has evolved with the development of pneumatic dilators and, more recently, local steroid injection and electrocauterization have been added. Endoscopic balloon dilatation (EBD) are used in exceptional cases, some with advantages over surgical intervention depending on each patient in particular and on the characteristics and etiology of the gastric outlet obstruction. Local steroid injection and electrocauterization can augment the effect of EBD.