title: Endoscopic antralplasty for severe gastric stasis after wide endoscopic submucosal dissection in the antrum.
abstract: A 75-year-old female underwent esophagogastroduodenoscopy, revealing a widely spreading tumor occupying the anterior wall, lesser curvature, and posterior wall of the antrum and lower body. Endoscopic submucosal dissection was performed and resulted in more than five-sixths circumferential antral mucosal resection. One month later, she complained of nausea, vomiting, and abdominal distention. Endoscopy showed residual food in the stomach and deformation of the antrum with traction toward the contracted scar in the lesser curvature. The pyloric ring could not be seen from the antrum although the endoscope was able to pass easily beyond the area of deformation and the pyloric ring was intact. Despite repeated endoscopic balloon dilations, the patient's symptoms remained refractory. The problem was speculated to be not due to any potential stricture but to antrum deformation resulting from the traction force toward the healing ulcer. We hypothesized that an additional countertraction force opposite the previous ESD site might resolve the problem, and ESD of approximately 2.5 cm size was performed in the greater curvature of the antrum. Along with development of a scar, traction toward the greater curvature was added, and the pyloric ring could be observed on repeat esophagogastroduodenoscopy. The symptoms were also gradually ameliorated. Afterwards, the endoscopic findings have now been unchanged during 7 years of follow-up.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Ohara
authors.affiliation: Department of Endoscopy, Kobe University Hospital, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Japan. toyonaga@med.kobe-u.ac.jp.|Department of Endoscopy, Kishiwada Tokushukai Hospital, Kishiwada, Japan. toyonaga@med.kobe-u.ac.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Toyonaga
authors.affiliation: Department of Endoscopy, Kishiwada Tokushukai Hospital, Kishiwada, Japan.|Department of Gastroenterology, Ikoma City Hospital, Ikoma, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Tanabe
authors.affiliation: Department of Endoscopy, Kishiwada Tokushukai Hospital, Kishiwada, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takihara
authors.affiliation: Department of Endoscopy, Kishiwada Tokushukai Hospital, Kishiwada, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Baba
authors.affiliation: Department of Endoscopy, Kishiwada Tokushukai Hospital, Kishiwada, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Department of Endoscopy, Kishiwada Tokushukai Hospital, Kishiwada, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Ono
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Kawara
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan.
authors.forename: Shinwa
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Azuma
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D002921:Cicatrix / Q000150:complications; D000069916:Endoscopic Mucosal Resection / Q000009:adverse effects* / Q000379:methods; D005260:Female; D018589:Gastroparesis / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications / Q000473:pathology / Q000601:surgery; D011706:Pyloric Antrum / Q000473:pathology / Q000601:surgery*; D013274:Stomach Neoplasms / Q000601:surgery*
keywords: Endoscopic antralplasty; Endoscopic submucosal dissection; Gastric stasis