Natural orifice endoluminal technique (NOEL) for the management of congenital duodenal membranes

Jonathan Goring, Sara Isoldi, Shishu Sharma, Filippo Torroni, Sean Marven, Paola De Angelis, Mike Thomson

Research output: Contribution to journalArticlepeer-review


Purpose: Congenital Partial Duodenal Obstruction (CPDO) caused by membranes/webs/diaphragms has traditionally been managed by open or laparoscopic duodenoduodenostomy or duodenojejunostomy. We report a two center 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, postoperative complications, length of stay, and need for further procedures. Results: Fifteen patients were treated over a 10 year period by NOEL technique for late presenting CPDO. Four patients were managed at Sheffield Children's Hospital (Center A, UK), and 11 patients were managed in Bambino Gesù Hospital of Rome (Center 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 Center A and 18 months (range 7–58) in Center 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 Center 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 owing to a fenestrated membrane should be considered for NOEL. Type of study: Case series. Level of evidence: Level IV.

Original languageEnglish
Pages (from-to)282-285
Number of pages4
JournalJournal of Pediatric Surgery
Issue number2
Publication statusE-pub ahead of print - 2019


  • Diaphragm dilatation
  • Duodenal stenosis
  • Duodenal web
  • Endoscopic intervention

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health


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