Treatment of Refractory Gastric Outlet Obstruction After Endoscopic Submucosal Dissection With Endoscopic Antralplasty and Stent Placement: A Case Report.

Abstract

Endoscopic submucosal dissection (ESD) has emerged as a standard minimally invasive treatment for early gastric cancer and precancerous lesions. However, extensive resection near the pyloric ring or antrum can lead to post-ESD gastric outlet obstruction (GOO) due to cicatricial stenosis and luminal deformation. This report presents a case of a 79-year-old man who developed severe GOO following ESD for an antral tubular adenoma with low-grade dysplasia. Initial management with endoscopic antralplasty and local triamcinolone injection failed to provide sustained symptomatic relief. As a salvage therapy, a partially covered self-expandable metallic stent (SEMS) was placed across the antrum, pyloric ring, and proximal duodenum. This intervention resulted in complete resolutions of obstructive symptoms and restoration of normal oral intake. The SEMS was successfully removed after 4 weeks with no recurrence of GOO symptoms thereafter. This case highlights the therapeutic challenges of post-ESD GOO and demonstrates that SEMS placement is a viable salvage treatment for refractory cases. Further studies are required to optimize treatment strategies and assess long-term outcomes.