Utility of a Plumber – HANARO stent in pyloric stenosis after circumferential ESD
On endoscopy, a 71-year-old man suffering from chronic, severe atrophic gastropathy, with areas of massive complete intestinal metaplasia presented with a 35-mm stage IIa/b nongranular, laterally sreading tumor ([Fig. 1]). It was narrow band imaging international colorectal endoscopic classification 2 and had a type VI pit pattern and affected 70 % of the circumference of the pylorus and extended through the antrum towards the greater curvature. Biopsies of the lesion showed a tubular adenoma with low-grade dysplasia, which prompted the decision to perform DSE.
Endoscopic submucosal dissection (ESD) was performed and an en-bloc specimen measuing 52 × 38 × 5 mm was obtained ([Fig. 2]). Histologic examination revealed chronic, moderate atrophic gastropathy with intestinal metaplasia and extensive areas of low- and high-grade intraepithelial neoplasia. The lateral and deep margins were disease-free ([Video 1]).
Video 1 Stenosis after ESD. Stent placement.
At 3 weeks after ESD, the patient presented with symptoms of pyloric stenosis and the diagnosis was confirmed endoscopically by observation of a short, puntiform pyloric stenosis (10 mm) ([Fig. 3]). Three sequential dilations were performed with a CRE balloon up to 18 mm with early restenosis on all occasions and with a progressive weight loss up to 12 kg. Finally, a 16- × 30-mm fully-covered metallic stent (Plumber HANAROSTENT; M.I. Tech, Korea) was placed, which led to clinical resolution of the stenosis at 3-month follow-up and progressive weight gain in the patient. The stent later was removed and the patient’s clinical course was positive.
22 October 2020 (online)
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