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. 2024 Mar;35(3):255-261.
doi: 10.5152/tjg.2024.23202.

A Classification for Gastric Outlet Obstruction in Childhood: Extending Beyond Infantile Hypertrophic Pyloric Stenosis

Ödül Eğritaş Gürkan  1 , Hakan Öztürk  1 , Cem Kaya  2 , Neslihan Gürcan Kaya  1 , Neslihan Ekşi Bozbulut  1 , Ayşe Can  1 , Kamercan Ceylan  1 , Aysel Ünlüsoy Aksu  1 , Demet Teker Düztaş  1 , Sinan Sarı  1 , Buket Dalgıç  1 , Alparslan Kapısız  2 , Demet Coşkun  3 , Gökçen Emmez  3 , Gözde İnan  3 , İsmail Akdulum  4 , Hakan Kutluk Pampal  3 , Nuray Camgöz Eryılmaz  3 , Selin Erel  3 , Volkan Şıvgın  3 , Ercan Yıldırım  3 , Okan Ermiş  3 , İrfan Güngör  3 , Gülay Kip  3 , Nurdan Bedirli  3 , Berrin Işık  3 , İbrahim Onur Özen  2 , Yusuf Hakan Çavuşoğlu  2 , Ramazan Karabulut  2 , Zafer Türkyılmaz  2 , Kaan Sönmez  2
Affiliations

A Classification for Gastric Outlet Obstruction in Childhood: Extending Beyond Infantile Hypertrophic Pyloric Stenosis

Ödül Eğritaş Gürkan et al. Turk J Gastroenterol. 2024 Mar.

Abstract

Background/aims: Gastric outlet obstruction (GOO) is a rare condition in childhood, with the exception of infantile hypertrophic pyloric stenosis (IHPS). However, no classification exists from a pediatric gastroenterologist's perspective.

Materials and methods: The patients with a diagnosis of GOO between 2009 and 2020 were reviewed retrospectively. We classified the patients according to GOO: presence of clinical findings accompanied by radiological and/or endoscopic findings; clinical status: intractable nonbilious postprandial vomiting alone or with abdominal pain, early satiety, weight loss, postprandial abdominal distension, and malnutrition; radiology: delayed gastric emptying and dilated stomach; endoscopy: nonbilious gastric contents after 6-8 hours of emptying and/or failed pyloric intubation; physical examination: visible gastric peristalsis.

Results: A total of 30 GOO patients (15 patients with IHPS, 1 patient with annular pancreas, 4 patients with gastric volvulus, 2 patients with duodenal atresia, 2 patients with antral web, 1 patient with late-onset hypertrophic pyloric stenosis (LHPS) had surgical treatment, and remaining 5 patients had medical treatment) were enrolled to the study. The median age was 8 months (range: 3 months-16 years), and 14 patients were female. Mitochondrial disorders, LHPS, metabolic disorders, and eosinophilic gastrointestinal system diseases were added to Sharma's GOO classification, and the classification has been expanded.

Conclusion: This is the first and largest study of GOO in children. From the perspective of pediatric gastroenterology, new diseases will be addressed, and definitions will be highlighted with our classification for GOO in childhood.

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Conflict of interest statement

Declaration of Interests: Ödül Eğritaş Gürkan is an associate editor at the Turkish Journal of Gastroenterology. Other authors have no conflict of interest to declare.

Figures

Figure 1.
Figure 1.
CT images of the patient diagnosed with gastric outlet obstruction and pancreatitis. On contrast-enhanced axial (B) and coronal reformatted (A, C) abdomen CT images, a lobulated, contoured, thin-walled cystic lesion (*) measuring 135 × 88 × 130 mm in the widest part and involving the body and tail of the pancreas is seen. Gastric lumen (white arrowheads) and PEG balloon (white arrow) can be distinguished superior to the cyst, and the pancreatic head and neck (black arrow) can be seen in the lateral aspect of the cyst. On the lateral side of the pancreatic head, we can also discern the natural course of the second and third portions of the duodenum (black arrowheads). CT, computed tomography; PEG, percutaneous endoscopic gastrostomy.
Figure 2.
Figure 2.
Direct x-ray, endoscopic, and intraoperative images of the antral web case presented with gastric outlet obstruction.
Figure 3.
Figure 3.
Work chart suggested in the diagnosis and differential diagnosis of gastric outlet obstruction. GOO, gastric outlet obstruction.
See this image and copyright information in PMC

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