title: Recanalization of severe gastric antral stricture after large endoscopic submucosal dissection: mucosal incision and local steroid injection.
abstract: Endoscopic submucosal dissection (ESD) of early gastric cancer is well-established in Japan. Although ESD enables en bloc resection of large lesions, it results in an extensive artificial ulcer that might lead to severe stricture, especially in case of large ESD in the pre-pylorus area. Here, we report two cases suffering from severe antral stenosis. The first case was refractory severe antral stenosis after a large ESD. Though we performed endoscopic balloon dilations, it remaind severe stricture. We made a mucosal incision on the opposite side of the ulcer scar and local triamcinolone acetonide (TA) injection into the incision site. In the second case there was considerable improvement of a pinhole stenosis using ESD counter-incision and local TA injection. Local steroid injection into the post-ESD artificial ulcer promotes the formation of granulation tissue of the healing process leading to regeneration of gastric mucosa without gastric deformity. Making a mucosal incision on the opposite side of post ESD ulcer and cutting the submucosal layer eases the mucosal tension, and the local injection of TA into a large artificial ulcer following ESD can prevent re-stenosis.
authors.affiliation: Department of Gastroeneterology, Kagawa Medical University School of Medicine, Kagawa, Japan. hiro4884@med.kagawa-u.ac.jp
authors.forename: Hirohito
authors.initials: H
authors.lastname: Mori
authors.forename: Hideki
authors.initials: H
authors.lastname: Kobara
authors.forename: Shintaro
authors.initials: S
authors.lastname: Fujihara
authors.forename: Noriko
authors.initials: N
authors.lastname: Nishiyama
authors.forename: Kazi
authors.initials: K
authors.lastname: Rafiq
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Masaki
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D004106:Dilatation / Q000379:methods; D004210:Dissection / Q000009:adverse effects; D005753:Gastric Mucosa / Q000601:surgery; D005773:Gastroscopy; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D011706:Pyloric Antrum / Q000601:surgery*; D011707:Pyloric Stenosis / Q000209:etiology / Q000628:therapy*; D013274:Stomach Neoplasms / Q000601:surgery*; D014222:Triamcinolone Acetonide / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D005938:Glucocorticoids; D014222:Triamcinolone Acetonide