Endoscopic Pyloromyotomy for the Treatment of Benign Pyloric Stenosis

Kimberly J. Kolkhorst, DO Jeffrey Gill, MD, University of South Florida, Department of Gastroenterology, Tampa, Florida We report the case of a 62-year-old female with a history migraines and non-steroidal anti-inflammatory drug (NSAID) use who presented to the emergency department with epigastric abdominal pain associated with intermittent nausea and vomiting for two months. Initial esophagogastroduodenoscopy (EGD) revealed a pyloric channel ulcer and pyloric stenosis with inability to pass a standard upper endoscope. The pyloric stenosis persisted after 10 weeks despite discontinuation of NSAIDs, initiation of twice daily proton pump inhibitor (PPI) and serial balloon dilations. The pyloric narrowing was subsequently treated with the application of a needle knife papillotome to all four quadrants and a second pyloromyotomy two months later. Repeat EGD at four months revealed a widely patent pylorus and the patient was asymptomatic at the time of this endoscopy.