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Endoscopic findings in hypertrophic pyloric stenosis: appearance in classic and evolving disease
C A Liacouras1, S D Cook-Sather, M S Schreiner
1Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine 19104, USA.
Insights
Endoscopy can reveal hypertrophic pyloric stenosis (HPS) in infants when ultrasounds are unclear. Recognizing evolving endoscopic signs of HPS is crucial for accurate diagnosis in infants.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Infant Health
Background:
- Hypertrophic pyloric stenosis (HPS) is a common infant surgical condition.
- Ultrasound is the primary diagnostic tool, but endoscopy is needed for equivocal cases.
- This study evaluates endoscopic findings in HPS.
Purpose of the Study:
- To describe the endoscopic appearances of HPS in infants.
- To compare endoscopic findings in HPS patients versus controls.
- To highlight the diagnostic utility of endoscopy in HPS.
Main Methods:
- Prospective study comparing 18 infants with HPS to 21 controls.
- Endoscopic examination of the antrum and pylorus.
- Assessment of mucosal hypertrophy and fold thickening.
Main Results:
- All 18 HPS infants showed antral or pyloric mucosal hypertrophy.
- Mucosal thickening varied with age and symptom duration.
- Control infants had no signs of narrowing or thickening.
Conclusions:
- Upper endoscopy is valuable for diagnosing HPS when imaging is inconclusive.
- Endoscopy aids diagnosis in infants presenting outside the typical HPS age range.
- Recognizing the diverse endoscopic presentations of HPS is essential.
Background:
Hypertrophic pyloric stenosis (HPS) is the most common abdominal surgical disorder in infants. Although the majority of cases are diagnosed by ultrasound, equivocal cases may require endoscopy. This study was performed to assess the various endoscopic appearances of HPS in infants.
Methods:
A prospective study comparing the endoscopic appearance of the antrum and pylorus of 18 children with HPS to 21 children in a normal control group.
Results:
Antral or pyloric mucosal hypertrophy was visualized endoscopically in all 18 study patients. The degree of mucosal thickening varied depending on the age of presentation and duration of symptoms. Antral fold hypertrophy was first noted at 10 days of age, and in the oldest patient (4 months of age) a pyloric mass was noted. By comparison, 21 control infants had no evidence of antral or pyloric narrowing or mucosal thickening.
Conclusions:
Upper endoscopy can be a valuable adjunctive diagnostic tool in select cases of HPS when imaging tests are inconclusive or when infants present with clinical symptoms outside the typical age-time frame for HPS. Because HPS may evolve over time, it is important that the endoscopist recognize the different appearances of HPS.