Natural orifice Endoluminal technique (NOEL) for the Management of Congenital Duodenal Membranes

Abstract Purpose Congenital Partial Duodenal Obstruction (CPDO) caused by membranes/webs/diaphragms has traditionally been managed by open or laparoscopic duodeno-duodenostomy or duodeno-jejunostomy. We report a two centre case series where Natural Orifice Endoluminal technique (NOEL) was used to treat children with CPDO. Methods A retrospective case series was evaluated. Data collected included the duration of procedure, post-operative complications, length of stay, and need for further procedures. Results Fifteen patients were treated over a ten year period by NOEL technique for late presenting CPDO. Four patients were managed at Sheffield Children's Hospital (Centre A, UK), and eleven patients were managed in Bambino Gesu Hospital of Rome (Centre B, Italy). 20% of the patients had more than one duodenal obstructing membrane. Both balloon dilatation and membrane incision techniques were used. Median follow up was 23 months (range 2–69) in Centre A and 18 months (range 7–58) in Centre B. 60% of patients were successfully treated with 1 NOEL procedure. 20% required 2 or 3 procedures to achieve long term luminal patency. 20% required surgery after NOEL failed to treat the partial obstruction definitively. One patient in Centre A required radiological drainage of a retroperitoneal collection following perforation during NOEL. Conclusion NOEL technique is feasible and effective in selected children with CPDO. Both balloon dilatation and incision techniques can be used. Care must be taken to rule out a second distal obstruction. We would recommend that all infants and children with CPDO due to a fenestrated membrane should be considered for NOEL. Type of study Case Series. Level of evidence Level IV.