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A Case of Pyloric Stenosis afterEsophagectomy Relieved by Implantation of a Self-expanding Metallic Stent.

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  • ステント留置が有効であった食道癌術後幽門通過障害の1例

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Abstract

We report a case of non-mechanical stenosis of the pylorus after an esophagectomy and a gastric pull-up operation for esophageal cancer which was successfully relieved by implantation of a self-expanding metallic stent. A 48-year-old man had recieved a subtotal esophagectomy and an intrathoracic esophagogastrostomy for esophageal carcinoma. After the operation, dilatation and right-sided protrusion of the intrathoracic gastric roll and stenosis of the pylorus were observed. An endoscopic examination showed no mechanical stenosis around the pylorus. Four times of balloon dilatations were unsuccessful. The patient had to receive daily drip infusion therapy in the outpatient clinic against malnutrition and dehydration. He developed recurrence to the cervical lymph node 3 months after the surgery, then radiation therapy was added. After radiation therapy, a non-covered self-expanding metallic stent was inserted through the pyloric ring and duodenal bulb under endoscopic observation. The patient was able to resume solid diet after this stent insertion. Though there is some controversy about the stent insertion for a benign stenotic lesion, this technique is very helpful for poor prognostic patients, because rapid restoration of diet intake is one of the most important issues from the viewpoint of the “quality of life”.

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