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A Classification for Gastric Outlet Obstruction in Childhood: Extending Beyond Infantile Hypertrophic Pyloric
Ödül Eğritaş Gürkan1, Hakan Öztürk1, Cem Kaya2
1Department of Pediatric Gastroenterology, Gazi University School of Medicine, Ankara, Turkey.
Insights
This study introduces a new classification for pediatric gastric outlet obstruction (GOO), expanding on existing frameworks. It incorporates rare conditions and provides a pediatric gastroenterology perspective for improved diagnosis and management.
Area of Science:
- Pediatric Gastroenterology
- Clinical Classification Systems
- Gastrointestinal Motility Disorders
Background:
- Gastric outlet obstruction (GOO) is uncommon in children, except for infantile hypertrophic pyloric stenosis (IHPS).
- Existing GOO classifications lack a pediatric gastroenterology perspective.
- A standardized classification is needed for accurate diagnosis and management of pediatric GOO.
Purpose of the Study:
- To develop and present a novel classification for pediatric gastric outlet obstruction (GOO).
- To incorporate rare causes of GOO and conditions relevant to pediatric gastroenterology.
- To provide an updated framework for diagnosing and managing GOO in children.
Main Methods:
- Retrospective review of 30 pediatric patients diagnosed with GOO between 2009 and 2020.
- Classification based on clinical, radiological, endoscopic, and physical examination findings.
- Expansion of Sharma's GOO classification to include new disease categories.
Main Results:
- The study identified 30 pediatric GOO cases, including IHPS, annular pancreas, gastric volvulus, duodenal atresia, antral web, and late-onset IHPS (LHPS).
- Mitochondrial disorders, LHPS, metabolic disorders, and eosinophilic gastrointestinal diseases were integrated into the classification.
- The expanded classification provides a more comprehensive approach to pediatric GOO.
Conclusions:
- This is the first and largest study to propose a pediatric gastroenterology-focused classification for GOO.
- The new classification addresses previously unaddressed diseases and refines definitions for childhood GOO.
- This framework will aid in the diagnosis and management of pediatric gastric outlet obstruction.
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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