title: Case series of endoscopic balloon dilation to treat a stricture caused by circumferential resection of the gastric antrum by endoscopic submucosal dissection.
abstract: BACKGROUND
  Endoscopic submucosal dissection (ESD) plays an important role in the management of gastric neoplasms. There are few reports regarding stricture development caused by ESD of gastric neoplasms.
  
  
  OBJECTIVE
  The present study aimed to determine the incidence of gastric stricture formation after ESD of gastric neoplasms and to report on the outcome and management of this complication: endoscopic intervention (ie, balloon dilation) versus surgery; the outcome of balloon dilation (success or failure/perforation).
  
  
  METHODS
  A case series from a retrospective review of gastric ESDs performed at Saga Medical School over a defined period of time.
  
  
  METHODS
  Double-center territory, referral hospital.
  
  
  METHODS
  An evaluation was performed in 532 patients with gastric mucosal tumors treated by ESD. A stricture was reported in 5 patients. All the 5 cases were located in the antrum. ESD that was performed in the cardia or the proximal stomach did not induce a stricture.
  
  
  RESULTS
  Of the 5 cases of symptomatic gastric outlet obstruction, 1 patient required surgical intervention because of a near total gastric outlet obstruction not amenable to endoscopic intervention. The 4 patients underwent step-serial through-the-scope balloon dilations; in 2 patients, the procedure was successful, but in the other 2 patients, the procedure was complicated by a gastric perforation (50% incidence of perforation).
  
  
  CONCLUSIONS
  A retrospective study.
  
  
  CONCLUSIONS
  Circumferential or subcircumferential resection by ESD in the antrum caused a stricture. Balloon dilation of the ESD gastric outlet obstruction might be a choice, but it is a risky treatment.
authors.affiliation: Department of Internal Medicine, Medical School Hospital and Saga Prefectual Hospital Koseikan, Saga Medical School, Saga, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Tsunada
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ogata
authors.forename: Kotaro
authors.initials: K
authors.lastname: Mannen
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Arima
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Sakata
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Shiraishi
authors.forename: Ryo
authors.initials: R
authors.lastname: Shimoda
authors.forename: Hibiki
authors.initials: H
authors.lastname: Ootani
authors.forename: Kanako
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: Takehiro
authors.initials: T
authors.lastname: Fujise
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sakata
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Iwakiri
authors.forename: Kazuma
authors.initials: K
authors.lastname: Fujimoto
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000236:Adenoma / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011706:Pyloric Antrum / Q000601:surgery*; D011707:Pyloric Stenosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D011860:Radiography, Abdominal; D013274:Stomach Neoplasms / Q000601:surgery