Abstract
Duodenal fenestrated membranes are traditionally treated by side-to-side diamond-shaped duodenoduodenostomy, or duodenotomy and resection. We describe an alternative endoscopic approach for its resolution. A flexible panendoscopy reaching the duodenal membrane was performed. A balloon was inserted to dilate its orifice. Traction was applied to the balloon to differentiate the border of the membrane forming the duodenal wall. After visualizing the ampulla, the membrane was incised using a sphincterotome or needle knife on two sites opposite to the bile duct. From May 2001 to August 2007, ten patients with a fenestrated duodenal membrane underwent transluminal endoscopic electrosurgical incision (TEEI). Mean patient age was 3.4 years (range 1 month to 15 years). The endoscopic procedure lasted from 30 to 60 min. Oral intake began 24 h postsurgery in eight patients and at 48 h postsurgery in two patients. Hospital stay lasted for 2–5 days. After 1 year of follow-up, eight patients were asymptomatic and thriving at present, and one had a double membrane, required a second endoscopy with TEEI, and has experienced occasional vomiting. An additional asymptomatic patient was lost after 3 months of follow-up. TEEI of fenestrated duodenal membranes is a feasible and effective procedure in children.
Similar content being viewed by others
References
Spigland N, Yazbeck S (1990) Complications associated with surgical treatment of congenital intrinsic duodenal obstruction. J Pediatr Surg 25:1127–1130
Weber TR, Lewis JE, Mooney D, Connors R (1986) Duodenal atresia: a comparison of techniques of repair. J Pediatr Surg 21:1133–1136
Brown RA, Millar AJW, Linegar SW, Moore SW, Cywes S (1994) Fenestrated duodenal membranes: an analysis of symptoms, signs, diagnosis, and treatment. J Pediatr Surg 29:429–432
Mikaelsson C, Arnbjörnsson E, Kullendorff CM (1997) Membranous duodenal stenosis. Acta Paediatr 86:953–955
Okamatsu T, Arai K, Yatsuzuka M, Ishikawa M et al (1989) Endoscopic membranectomy for congenital duodenal stenosis in an infant. J Pediatr Surg 24:367–368
Ziegler K, Schier F, Waldschmidt J (1992) Endoscopic laser resection of a duodenal membrane. J Pediatr Surg 27:1582–1583
Kay GA, Lobe TE, Custer MD, Hollabaugh RS (1992) Endoscopic laser ablation of obstructing congenital duodenal webs in the new born: a case report of limited success with criteria for patient selection. J Pediatr Surg 27:279–281
Nose S, Kubota A, Kawahara H et al (2005) Endoscopic membranectomy with a high-frequency-wave snare/cutter for membranous stenosis in the upper gastrointestinal tract. J Pediatr Surg 40:1486–1488
Blanco RG, Penchyna GJ, Trujillo PA, Nieto ZJ (2005) Primer caso de correccción no quirúrgica de una atresia duodenal tipo membrana fenestrada en un recién nacido mediante sección y ampliación por endoscopia. Bol Med Hosp Infant Mex 62:45–49
Rothenberg SS (2002) Laparoscopic duodenoduodenostomy for duodenal obstruction in infants and children. J Pediatr Surg 37:1088–1089
Ziu-ul-Miraj M, Madden NP, Brereton RJ (1999) Simple incision: a safe and definitive procedure for congenital duodenal diaphragm. J Pediatr Surg 34:1021–1024
Author information
Authors and Affiliations
Corresponding author
Additional information
The authors state that the present study has been approved by the Hospital ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. We also state that all the parents of the patients included in this study gave their informed consent prior to the realization of the procedure.
Rights and permissions
About this article
Cite this article
Blanco-Rodríguez, G., Penchyna-Grub, J., Porras-Hernández, J.D. et al. Transluminal endoscopic electrosurgical incision of fenestrated duodenal membranes. Pediatr Surg Int 24, 711–714 (2008). https://doi.org/10.1007/s00383-008-2142-8
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-008-2142-8