Requiring Surgery Due to Passage Obstruction Caused by Stenosis and Deformity after ESD for Semi-circular Early Gastric Cancer in the Antrum, Report of a Case Hirofumi Izumoto 1 , Toshiyuki Yoshio 1 , Ken Namikawa 1 , Yoshitaka Tokai 1 , Shoichi Yoshimizu 1 , Yusuke Horiuchi 1 , Akiyoshi Ishiyama 1 , Toshiaki Hirasawa 1 , Tomohiro Tsuchida 1 , Junko Fujisaki 1 1Department of Gastroenterology, Cancer Institute Hospital, Tokyo Keyword: ESD後潰瘍 , 狭窄 , 通過障害 , 内視鏡的バルーン拡張術 , 外科手術 pp.114-119
Published Date 2021/1/25
DOI https://doi.org/10.11477/mf.1403202234
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 A male patient in his 80s underwent EGD(esophagogastroduodenoscopy)due to an abnormality in his upper gastrointestinal series and had a suspected cancer lesion detected in a previous hospital. He was referred to our hospital for treatment. A whitish, flat, elevated lesion was found in the background mucosal atrophy of open type(after spontaneous eradication)in the lesser curvature, and there was extension of the flat cancer sub-circumferentially, however there was no lesion observed in the greater curvature. Upon admission, preoperative biopsy revealed a well-differentiated tubular adenocarcinoma. The lesion was diagnosed as early gastric cancer, L, Circ, Type 0-IIa+IIb, 90mm, tub1, cT1a-M, UL0. A curative resection of this lesion was performed using ESD(endoscopic submucosal dissection). However, 40 days after ESD, the patient was re-admitted with complaints of repeated vomiting. An EGD was performed, which demonstrated mild stenosis due to post-ESD ulcer ; however the scope passed satisfactorily. We also found a deformity, which was thought to be causing the obstruction. A total of six endoscopic balloon dilatations were performed ; however, the symptoms did not improve. Finally, laparoscopic distal gastrectomy was performed. Postoperative stenosis and obstruction of the passage can occur after ESD performed for treatment of extensive lesions of the pyloric antrum. It is important to note that unlike simple stenosis, if deformities are present, endoscopic balloon dilatation may not be of much help and surgical intervention may be required.

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