INCIDENCE, RISK AND MANAGEMENT OF PYLORIC STENOSIS AFTER GASTRIC ENDOSCOPIC SUBMUCOSAL DISSECTION: EXPERIENCE OF A WESTERN CENTER

Aims We aimed to evaluate incidence, risk and management of pyloric stenosis (PS) after gastric endoscopic submucosal dissection (ESD).

Methods We reviewed 262 superficial gastric neoplasms who underwent ESD at a Portuguese center between January 2012-October 2021. Pyloric involvement was considered if the neoplasm or the scar affected the pylorus. PS was diagnosed if a standard endoscope could not pass the pylorus. Oral corticosteroids were prophylactically administered if pyloric involvement with a mucosal defect of>75% of the circumference. Surveillance endoscopy was performed 3-6 months after discharge, earlier if symptoms developed.

Results Among the 262 gastric ESD, 43.5% (n=114) neoplasms were in the antrum and the pylorus was involved in 27.2% (n=31) (direct involvement: n=16; scar only: n=15). Regarding the mucosal defect, 5.3% of scars occupied>75% of the circumference. The incidence of PS was 9.7% (n=3) if the pylorus was involved (P<0.01). All cases of PS had direct involvement of the pylorus and a mucosal defect>75%. Lesion size was significantly associated with PS (P<0.001) but morphology and fibrosis did not correlate. Endoscopic balloon dilation was used in 2 cases, together with topical corticosteroids, while the remaining case received surgery due to non-curative resection.

Table 1

Risk factors for pyloric stenosis after ESD of superficial gastric neoplasms in the antrum (n=114)		Pyloric stenosis (n=3)	No pyloric stenosis (n=111)	p-value
Lesion size	≥30 mm	100%	7.21%	<0.001
Extent of mucosal defect	>75%	100%	2.7%	<0.001
Involvement of pylorus	Direct	100%	11.71%	<0.01
	Scar only	0%	13.51%

Conclusions The incidence of PS after gastric ESD was low (1.2%) in a Western center but it was 9.7% if pyloric involvement. Endoscopic balloon dilation and corticosteroids were effective for management. PS only occurred in large superficial gastric neoplasms directly involving the pylorus leaving a mucosal defect>75%. Prophylactic manners, like oral corticosteroids, may be justifiable in these cases.

Publication History

Article published online:
14 April 2022