title: Risk factors and management for pyloric stenosis occurred after endoscopic submucosal dissection adjacent to pylorus.
abstract: Endoscopic submucosal dissection (ESD) has been widely accepted as a curative treatment for gastric neoplasm. Pyloric stenosis is a chronic complication that can be caused by ESD. The aim of this study is to clarify the risk factors and management for pyloric stenosis. From January 2004 to January 2014, a total of 126 patients who underwent ESD adjacent to pylorus were reviewed retrospectively. Pyloric mucosal defect was defined as when any resection margin of ESD was involved in the pyloric ring. Pyloric stenosis was defined as when a conventional endoscope could not be passed to the duodenum. Among the 126 patients, pyloric stenosis was identified in 9. In a univariate analysis, pyloric stenosis was more common in older patients (P < 0.05) and in lesions with resections over 75% of the pyloric ring circumference (P < 0.001). In a multivariate analysis, the factor that was associated with pyloric stenosis was the extent of the pyloric ring dissection (P < 0.001). Four of the 9 patients with pyloric stenosis had mild dyspepsia, and the others had gastric outlet obstruction symptoms. The 5 symptomatic patients underwent endoscopic balloon dilation (EBD), and the frequency of EBD was 1 to 8 times. The asymptomatic patients were treated conservatively. The incidence of pyloric stenosis was higher in lesions with resections over 75% of the pyloric ring circumference. Although EBD was an effective treatment for pyloric stenosis, conservative management was also helpful in patients who had mild symptoms.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea.
authors.forename: Jae Un
authors.initials: JU
authors.lastname: Lee
authors.forename: Moon Sik
authors.initials: MS
authors.lastname: Park
authors.forename: So Hee
authors.initials: SH
authors.lastname: Yun
authors.forename: Min A
authors.initials: MA
authors.lastname: Yang
authors.forename: Shang Hoon
authors.initials: SH
authors.lastname: Han
authors.forename: Young Jae
authors.initials: YJ
authors.lastname: Lee
authors.forename: Gum Mo
authors.initials: GM
authors.lastname: Jung
authors.forename: Ji Woong
authors.initials: JW
authors.lastname: Kim
authors.forename: Yong Keun
authors.initials: YK
authors.lastname: Cho
authors.forename: Jin Woong
authors.initials: JW
authors.lastname: Cho
mesh_terms: D000368:Aged; D000069916:Endoscopic Mucosal Resection / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D011707:Pyloric Stenosis / Q000209:etiology* / Q000628:therapy; D011708:Pylorus / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013274:Stomach Neoplasms / Q000601:surgery