Endoscopic diagnosis, management and outcome of gastroduodenal tuberculosis

Current guidelines for gastroduodenal tuberculosis suggest that surgery in conjunction with anti-tubercular therapy (ATT) is the primary therapy. We determined the efficacy of endoscopic balloon dilatation along with ATT as the primary treatment for this condition. Patients with gastric outlet obstruction at endoscopy seen over a two-year period underwent multiple biopsies from the involved area. Those in whom mucosal biopsy revealed non-specific inflammation, underwent endoscopic mucosal resection (EMR). Patients showing granulomatous inflammation with/without acid-fast bacilli (AFB) underwent endoscopic balloon dilatation under fluoroscopic guidance along with ATT. End point of dilatation was taken as dilatation with 18 mm balloon. The time taken to resume normal diet post endotherapy was determined. Thirteen patients were diagnosed to have gastroduodenal tuberculosis. Granulomatous inflammation with or without demonstration of AFB was documented in 92 % of the patients by endoscopic biopsy and EMR. Endoscopic balloon dilatation of the strictures was successful in 11/12 patients (92 %); these patients could resume their normal diet at a median of 11 days (range 7-60) post-dilatation. Retroperitoneal perforation in 1 patient was managed conservatively. Endoscopic therapy in combination with ATT is recommended as the first line therapy for gastroduodenal tuberculosis. Surgical intervention is reserved for the minority in whom endoscopic therapy fails.