Successful outcomes of endoscopic resection for gastric adenomas and early cancers located on the pyloric ring (with video).

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.

DESIGN

Case series.

SETTING

Tertiary-care referral center.

PATIENTS

This study involved 16 patients with 5 gastric adenomas and 11 early cancers that were located on the pyloric ring.

INTERVENTIONS

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.

MAIN OUTCOME MEASUREMENTS

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.

LIMITATIONS

Small number of patients.

CONCLUSION

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.