Successful outcomes of endoscopic resection for gastric adenomas and early cancers located on the pyloric ring (with video).
BACKGROUND
Endoscopic resection is difficult to perform in patients who have gastric neoplasms located on the pyloric ring, especially for lesions that extend from the pyloric area to the duodenal bulb, where it is difficult to retroflex the endoscope, and the risk of perforation is increased.


OBJECTIVE
To assess the results of endoscopic resection of early gastric neoplasms located on the pyloric ring.


METHODS
Case series.


METHODS
Tertiary-care referral center.


METHODS
This study involved 16 patients with 5 gastric adenomas and 11 early cancers that were located on the pyloric ring.


METHODS
After a retroflexion trial within the duodenum for evaluation of tumor extension from the pyloric area to the duodenal bulb, en bloc resection was attempted. Endoscopic submucosal dissection was attempted at the duodenal bulb with an endoscope retroflexed for cases of duodenal invasion.


METHODS
The curative resection rate, en bloc resection rate, and complications were determined.


RESULTS
The success rate of retroflexion within the duodenum was 88% (14 of 16). The curative resection rate was 81.3% (13 of 16), and the en bloc resection rate was 75% (12 of 16). En bloc resection was possible for 3 of 4 (75%) cases of duodenal bulb extension. Major procedure-related complications were not encountered.


CONCLUSIONS
Small number of patients.


CONCLUSIONS
Endoscopic resection appears to be a feasible and effective treatment for early gastric neoplasms located on the pyloric ring, including lesions that extend from the pyloric area to the duodenal bulb.
Jung
Seok Won
SW
Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea.
Jeong
In Du
ID
Bang
Sung-Jo
SJ
Shin
Jung Woo
JW
Park
Neung Hwa
NH
Kim
Do Ha
DH
D000236:Adenoma / Q000601:surgery*; D000368:Aged; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011708:Pylorus; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome; D014741:Video Recording