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.

Management of adverse events related to endoscopic resection of upper gastrointestinal neoplasms: Review of the literature and recommendations from experts

“…Some observational studies indicated that one of the important risk factors for stenosis after gastric ESD in both cardia and pylorus was circumference of resection wound >3/4 …”

“…Stenosis after gastric ESD is mainly treated by EBD. Two articles reported that there was no perforation related to EBD for cardiac stenosis, whereas perforation that developed during EBD for pyloric stenosis required emergency surgery . Two interesting reports described the usefulness of mucosal incision of stenotic ulcer scar and subsequent steroid injection …”

“…Some observational studies indicated that one of the important risk factors for stenosis after gastric ESD in both cardia and pylorus was circumference of resection wound >3/4. [118][119][120][121][138][139][140] Methods and efficacy of prevention for gastric stenosis is controversial. One study reported prophylactic EBD was not effective in reducing the total number of EBD sessions.…”

“…Two articles reported that there was no perforation related to EBD for cardiac stenosis, 118,119 whereas perforation that developed during EBD for pyloric stenosis required emergency surgery. [118][119][120]144 Two interesting reports described the usefulness of mucosal incision of stenotic ulcer scar and subsequent steroid injection. 143,145 Systematic literature search formula for English publication was [gastric endoscopic submucosal dissection] AND [stenosis] OR [stricture].…”

Upper Gastrointestinal Manifestation of Bezoars and the Etiological Factors: A Literature Review

“…Pyloric obstruction can also be a result of Bouveret's syndrome [24] and bacterial infection of the gastric wall or gastric wall abscess after cholecystitis [26]. Endoscopic submucosal dissection of the pyloric ring has also been found to be a risk factor for pyloric stenosis [38].…”