Miyake Muneaki, Nishimura Naoyuki, Shimodate Yuichi, Doi Akira, Mouri Hirokazu, Matsueda Kazuhiro, Mizuno Motowo
Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan.
Clin J Gastroenterol. 2019 Aug;12(4):307-309. doi: 10.1007/s12328-019-00955-1. Epub 2019 Mar 6.
An 84-year-old woman with pneumonia, congestive heart failure and chronic renal failure presented for iron-deficiency anemia and appetite loss. Esophagogastroduodenoscopy revealed a 60-mm sub-pedunculated tumor arising from the antrum of the stomach. The tumor was friable, with bleeding, and prolapsed into the duodenal bulb, the ball valve syndrome. The tumor was considered the cause of the anemia and appetite loss. Attempted endoscopic reduction of the prolapsing tumor was unsuccessful, but the base of its stalk could be identified through the transparent hood; thus, we removed the tumor with endoscopic submucosal dissection. The tumor was retrieved successfully, and pathohistological examination revealed the tumor to be a well-differentiated adenocarcinoma. This case suggests that endoscopic submucosal dissection is useful as an alternative to surgery for removal of gastric tumors that have prolapsed into the duodenal bulb when polypectomy was difficult, but provided the tumor's attachment site can be identified endoscopically.
一名84岁女性，患有肺炎、充血性心力衰竭和慢性肾衰竭，因缺铁性贫血和食欲减退前来就诊。食管胃十二指肠镜检查发现胃窦部有一个60毫米的亚蒂状肿瘤。肿瘤质地脆，有出血，并脱垂至十二指肠球部，即球阀综合征。该肿瘤被认为是贫血和食欲减退的原因。尝试通过内镜将脱垂的肿瘤复位未成功，但通过透明帽可识别其蒂部；因此，我们采用内镜黏膜下剥离术切除了肿瘤。肿瘤成功取出，病理组织学检查显示该肿瘤为高分化腺癌。本病例表明，当息肉切除术困难但能在内镜下识别肿瘤附着部位时，内镜黏膜下剥离术可作为一种替代手术的方法，用于切除脱垂至十二指肠球部的胃肿瘤。
