Recanalization of severe Gastric Antral stricture after Large Endoscopic submucosal Dissection: mucosal Incision and Local steroid Injection

Abstract

Endoscopic submucosal dissection (ESD) of early gastric cancer is well-established in Japan. Although ESD enables en bloc resection of large lesions, it results in an extensive artificial ulcer that might lead to severe stricture, especially in case of large ESD in the pre-pylorus area. Here, we report two cases suffering from severe antral stenosis. The first case was refractory severe antral stenosis after a large ESD. Though we performed endoscopic balloon dilations, it remaind severe stricture. We made a mucosal incision on the opposite side of the ulcer scar and local triamcinolone acetonide (TA) injection into the incision site. In the second case there was considerable improvement of a pinhole stenosis using ESD counter-incision and local TA injection. Local steroid injection into the post-ESD artificial ulcer promotes the formation of granulation tissue of the healing process leading to regeneration of gastric mucosa without gastric deformity. Making a mucosal incision on the opposite side of post ESD ulcer and cutting the submucosal layer eases the mucosal tension, and the local injection of TA into a large artificial ulcer following ESD can prevent re-stenosis.