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

Abstract

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.