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DOI: 10.1055/a-0957-2754
Nonsurgical management of gastroduodenal tuberculosis: Nine-year experience from a tertiary referral center
Publication History
submitted 06 June 2018
accepted after revision 15 October 2018
Publication Date:
01 October 2019 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00025476/201910/lookinside/thumbnails/1271_10-1055-a-0957-2754-1.jpg)
Abstract
Background and study aims Gastroduodenal tuberculosis (GDTB) is an uncommon disease. Surgery has been standard of care both for diagnosis and management of GDTB. The aim of this study was to evaluate the efficacy of non-surgical management of GDTB using a combination of anti-tuberculous therapy (ATT) along with endoscopic dilatation of the tuberculous stricture.
Patients and methods Patients suspected to have gastroduodenal TB were evaluated: clinical, endoscopic, radiological, and histopathological data were recorded. Patients in whom a definite diagnosis of tuberculosis could not be confirmed on mucosal biopsies underwent endoscopic mucosal resection (EMR). Patients were treated with ATT and endoscopic dilatation was done if indicated. Patients were followed up to evaluate clinical, radiological and endoscopic response.
Results Over a 9-year period from 2009 to 2017, 52 patients (mean age 28.5yrs) were diagnosed with GDTB. The most common presenting symptoms were vomiting (n = 51, 98 %) and weight loss (n = 52,100 %). The most common anatomical site of involvement was D1–D2 junction (n = 22, 42 %). Histopathological diagnosis could be made in 43 patients (82.6 %); 36 (69 %) on mucosal biopsies and in 7 of 10 patients (70 %) who underwent snare biopsy/EMR. Endoscopic dilatation was done in 37 patients (71 %) and median dilatation sessions were two. Failure of endotherapy occurred in four patients (7.6 %). All responders had complete amelioration of symptoms after 4 to 6 weeks of combination therapy. Median period of follow-up was 23.5 months and none of the patients reported any recurrence of symptoms.
Conclusion ATT and endoscopic dilatation combined has a high success rate in management of GDTB and should be considered the standard of care.
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References
- 1 Rathi P, Gambhire P. Abdominal tuberculosis. J Assoc Physicians India 2016; 64: 38-47
- 2 Bhansali SK. Abdominal tuberculosis. Experiences with 300 cases. Am J Gastroenterol 1977; 67: 324-337
- 3 Sharma MP, Bhatia V. Abdominal tuberculosis. Indian J Med Res 2004; 120: 305
- 4 Debi U, Ravisankar V, Prasad KK. et al. Abdominal tuberculosis of the gastrointestinal tract: Revisited. World J Gastroenterol WJG 2014; 20: 14831-14840
- 5 Rao YG, Pande GK, Sahni P. et al. Gastroduodenal tuberculosis management guidelines, based on a large experience and a review of the literature. Can J Surg 2004; 47: 364
- 6 Chavhan GE. Duodenal Tuberculosis: Radiological Features on barium studies and their clinical correlation in 28 cases. J Postgrad Med 2003; 49: 214
- 7 Agrawal S, Shetty SV, Bakshi G. Primary hypertrophic tuberculosis of the pyloroduodenal area: report of 2 cases. J Postgrad Med 1999; 45: 10-12
- 8 Ali W, Sikora SS, Banerjee D. et al. Gastroduodenal tuberculosis. Aust N Z J Surg 1993; 63: 466-467
- 9 Puri AS, Sachdeva S, Mittal VV. et al. Endoscopic diagnosis, management and outcome of gastroduodenal tuberculosis. Indian J Gastroenterol 2012; 31: 125-129
- 10 Maharshi S, Puri AS, Sachdeva S. et al. Aetiological spectrum of benign gastric outlet obstruction in India: new trends. Trop Doct 2016; 46: 186-191
- 11 Negi SS, Sachdev AK, Chaudhary A. et al. Surgical management of obstructive gastroduodenal tuberculosis. Trop Gastroenterol Off J Dig Dis Found 2003; 24: 39-41
- 12 Jain S, Kumar N, Jain SK. Gastric tuberculosis. Endoscopic cytology as a diagnostic tool. Acta Cytol 2000; 44: 987-992
- 13 Vij JC, Ramesh GN, Choudhary V. et al. Endoscopic balloon dilation of tuberculous duodenal strictures. Gastrointest Endosc 1992; 38: 510-511
- 14 Rana SS, Bhasin DK, Chandail VS. et al. Endoscopic balloon dilatation without fluoroscopy for treating gastric outlet obstruction because of benign etiologies. Surg Endosc 2011; 25: 1579-1584