Transoral technologies in treating congenital duodenal stenosis

Introduction. The transoral endoscopic surgery performed through the natural orifices of the human body can reduce the rate of complications associated with surgical procedures and general anesthesia.
The aim of the present study was to reveal potentials in restoring the duodenal patency using NOTES technologies.
Material and methods. The researchers assessed outcomes of surgical treatment of 4 patients with partial congenital duodenal obstruction who were operated on in two medical institutions of the Siberian Federal District: Ivano-Matreninsky Children’s Clinical Hospital in Irkutsk 2 patients and Maternity and Childhood Center in Krasnoyarsk 2 patients. The trial period lasted over the past 5 years, since January 2015. Two endoluminal techniques for restoring the duodenal patency were used balloon dilatation of stenosis and endoscopic membranotomy. In the final part of the study, demographic data, intraand postoperative parameters and treatment outcomes were analyzed.
Results. All endoscopic procedures were successfully completed without conversion to laparotomy. In average, it took 25 minutes to restore the lumen of the duodenum (range 20-30 minutes). One patient showed moderate bleeding from the destroyed membrane after balloon dilatation which was stopped by electrocoagulation. Patients’ follow-up revealed that in one of them the disease returned one month later after the balloon dilatation. Repeated balloon dilation relieved the patient of the disease symptoms.
Conclusion. Endoluminal techniques for treating congenital partial duodenal obstruction are feasible and can be successfully performed in most patients. Our experience has shown that this surgery can be done by both balloon dilatation and by endoscopic membranotomy.