INTRODUCTION: Duodenotomy and resection or lateral duodenoduodenostomy by open or endoscopic surgery has been the traditional treatment of fenestrated duodenal membranes. A radial endoluminal incision of the membrane can widen its diameter and resolve the duodenal obstruction.
OBJECTIVE: We describe a new endoscopic procedure for membranectomy of fenestrated duodenal membranes.
METHODS: Under general anesthesia and endotracheal intubation, we introduced a flexible videopanendoscope into the second duodenal portion to visualize the membrane. Through the fenestration, we inserted a triple-lumen stone extraction balloon of 15 mm. After insufflation, we performed gentle traction to expose the membrane and distinguish its border from the duodenal wall. We dilated the orifice and advanced the endoscope to localize Vater's ampoule. Using a sphincterotome, we performed 1 or 2 radial cuts of 1.5 to 2.0 cm in the membrane in an opposite direction to the ampoule.
RESULTS: We performed this procedure on 10 patients. The mean duration of the procedure was 50 minutes. No patient had postoperative pain. Abdominal condition was normal, and all patients started oral intake 18 to 24 hours after the endoscopy. Patients were discharged asymptomatic. They completed 4 months to 4 years of follow-up. Eight continued to be asymptomatic. One had a double duodenal membrane and after 2 endoscopic cuts has occasional vomiting. Another 1 was lost to follow-up.
CONCLUSIONS: Transluminal endoscopic treatment of fenestrated duodenal membranes has been a safe procedure that may be an effective and less invasive alternative to open or laparoscopic surgery.
Submitted by Gerardo Blanco-Rodriguez
- Copyright © 2008 by the American Academy of Pediatrics