Utility of a Plumber – HANARO stent in pyloric stenosis after circumferential ESD

Introduction 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. Fig. 1 Lesion Endoscopy 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 ]). Fig. 2 Post-ESD image Video 1 Stenosis after ESD. Stent placement. Quality: mobile 360 480 720 Download 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. Fig. 3 Stenosis # Publication History Article published online: 22 October 2020 © 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

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