Efficacy and safety of endoscopic submucosal dissection for pyloric neoplasms.

Background and aims: Although endoscopic resection is widely accepted for pyloric lesions, endoscopic submucosal dissection (ESD) of pyloric neoplasms remains technically challenging. The study aimed to assess the efficacy and safety of ESD for pyloric neoplasms.

Methods: From June 2011 to August 2024, we retrospectively analyzed 103 patients with pyloric neoplasms who underwent ESD at the Endoscopy Center of Zhongshan Hospital. Clinical data,‌ including patient demographics, procedural outcomes, and follow-up results, were collected.

Results: Among 103 lesions, there were 36 prepyloric neoplasms, 49 pyloric neoplasms and 18 postpyloric neoplasms. The median lesion size was 31 mm (range 10-85 mm). The postpyloric group showed longer procedure duration (32 min vs. 39 min vs. 46 min, P = 0.029) and lower rate of en bloc resection (100.0% vs. 95.9% vs. 83.3%, P = 0.026) compared with the prepyloric group and pyloric group. No patients required conversion to open surgery. After procedure, delayed bleeding occurred in ‌one patient each‌ from the prepyloric and pyloric groups. During a median follow-up of 25 months (range: 6-81 months), only ‌one recurrence‌ (pyloric group) was observed. Post-ESD pyloric stenosis developed in 5 patients, all of whom achieved ‌symptomatic relief‌ through endoscopic balloon dilation (EBD) without complications.

Conclusions: ESD is a feasible and safe treatment for pyloric neoplasms. Additionally, EBD appears to be a safe and effective ‌therapeutic approach for post-ESD pyloric stenosis.