A case of early stage gastric cancer spreading to the pyloric ring resected endoscopically

Abstract

A 65-year-old man with history of early stage gastric cancer resected endoscopically about 2 years ago presented another early stage gastric cancer (type 0-IIc) in the lesser curvature of the prepylorus spreading to the pyloric ring. 1 cm in diameter. It was difficult to invert a usual endoscope in the bulbus, therefore the duodenal side of the lesion was not able to be observed. The early gastric cancer lesion sprending in the bulbus was able to be observed by using a small caliber endoscope (XP260, Olympus Optical Co.) . He underwent endoscopic submucosal dissection (ESD) . At first, the duodenal mucosal layer of the lesion was able to be cut more easily and safely by inversion of the endoscope in the bulbus with a disposable attachment and a thinner knife. Next, the gastric mucosal layer was cut and finally, the lesion was resected en block with strip biopsy method by using a double channel endoscope. Neither bleeding nor perforation occurred during the procedure. Pathological findings revealed well-differentiated adenocarcinoma in the mucosal layer and the margin was negative for cancer cells. The resected site was scarred without recurrence and stenosis after 2 months. This case is the rare reported one of early stage gastric cancer spreading to the pyloric ring resected en block with ESD by using a small caliber endoscope.