A CASE OF PYLORIC STENOSIS AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION OF EARLY GASTRIC CANCER

Abstract

The patient was a 71-year-old man with gastric cancer. A superficial elevated and depressed (0-IIa+IIc type) early gastric cancer located on the greater curvature of the pre-pylorus. We suspected the lesion was limited in the mucosal layer by the findings of endoscopy and endoscopic ultra sonography. We judged the lesion was expanded indication in endoscopic therapy. The lesion was resected by endoscopic submucosal dissection (ESD) procedure using an IT knife. An ulcer with four-fifths circumference on the pre-pylorus was observed after ESD. But, pylorus ring was intact. Pathological findings of the resected specimen showed a well differentiated adenocarcinoma (73×25mm) with a clear lateral margin. There were no complications such as postoperative bleeding and perforation. He discharged 1 week after ESD. On postoperative day 30, he complained of abdominal fullness. Abdominal X-ray examination showed dilatated stomach, endoscopy was done and he was diagnosed as having pylorus stenosis. Endoscopic balloon dilation was performed twice. He enabled to take meal after these procedure. We experienced a case of pyloric stenosis after endoscopic submucosal dissection for early gastric cancer and successfully treated by endoscopic balloon dilation. We have to perform preventive dilation, if we resect a large area of a pre-pylorus by ESD.