title: Successful outcomes of endoscopic resection for gastric adenomas and early cancers located on the pyloric ring (with video).
abstract: 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.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea.
authors.forename: Seok Won
authors.initials: SW
authors.lastname: Jung
authors.forename: In Du
authors.initials: ID
authors.lastname: Jeong
authors.forename: Sung-Jo
authors.initials: SJ
authors.lastname: Bang
authors.forename: Jung Woo
authors.initials: JW
authors.lastname: Shin
authors.forename: Neung Hwa
authors.initials: NH
authors.lastname: Park
authors.forename: Do Ha
authors.initials: DH
authors.lastname: Kim
mesh_terms: 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