Letters To The Editor
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World J Gastrointest Endosc. Dec 16, 2010; 2(12): 413-416
Published online Dec 16, 2010. doi: 10.4253/wjge.v2.i12.413
Idiopathic non-hypertrophic pyloric stenosis in an infant successfully treated via endoscopic approach
Wikrom Karnsakul, Mary L Cannon, Stacey Gillespie, Richard Vaughan
Wikrom Karnsakul, Division of Pediatric Gastroenterology and Nutrition, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United State
Wikrom Karnsakul, Mary L Cannon, Stacey Gillespie, Richard Vaughan, Department of Pediatrics, West Virginia University School of Medicine Morgantown, WV 26506, United States
Author contributions: Karnsakul W, Cannon ML, Gillespie S and Vaughan R are clinical providers who contributed to the care of this child during hospitalization, proofread and approved this manuscript.
Correspondence to: Wikrom Karnsakul, MD, Assistant Professor, Division of Pediatric Gastroenterology and Nutrition, Johns Hopkins University School of Medicine, Brady 320, 600 North Wolfe Street, Baltimore, MD 21287, United States. wkarnsa1@jhmi.edu
Telephone: +1-410-9558769 Fax: +1-410-9551464
Received: July 14, 2010
Revised: September 27, 2010
Accepted: October 4, 2010
Published online: December 16, 2010

Non-peptic, non-hypertrophic pyloric stenosis has rarely been reported in pediatric literature. Endoscopic pyloric balloon dilation has been shown to be a safe procedure in treating gastric outlet obstruction in older children and adults. Partial gastric outlet obstruction (GOO) was diagnosed in an infant by history and confirmed by an upper gastrointestinal series (UGI). Abdominal ultrasonography and computed tomography scan excluded idiopathic hypertrophic pyloric stenosis, abdominal tumors, gastrointestinal and hepato-biliary-pancreatic anomalies. Endoscopic findings showed a pinhole-sized pylorus and did not indicate peptic ulcer disease, Helicobacter pylori infection, antral web, or evidence of allergic and inflammatory bowel diseases. Three sessions of a step-wise endoscopic pyloric balloon dilation were conducted under general anesthesia and a fluoroscopy at two week intervals using catheter balloons (Boston Scientific Microvasive®, MA, USA) of increasing diameters. Repeat UGI after the first session revealed normal gastrointestinal transit and no intestinal obstruction. The patient tolerated solid food without any gastrointestinal symptoms since the first session. The endoscope was able to be passed through the pylorus after the last session. Although the etiology of GOO in this infant is unclear (proposed mechanisms are herein discussed), endoscopic pyloric balloon dilation was a safe procedure for treating this young infant with non-peptic, non-hypertrophic pyloric stenosis and should be considered as an initial approach before pyloroplasty in such presentations.

Keywords: Non-hypertrophic pyloric stenosis, Endoscopic pyloric balloon dilation, Gastric outlet obstruction