A 57-year-old
man presented with repeated vomiting, upper abdominal distension, weight loss,
and epigastric pain was admitted to our hospital. The patient gave a history of
a similar attack 3 years ago, and the endoscopy revealed partial pyloric
obstruction. The patient was advised to fast three days before the upper
digestive endoscopy and was maintained on intravenous fluids. Upper gastrointestinal
endoscopy revealed multiple ulcers# around the pyloric ring, totally obstructed
pyloric ring#, elongated and large stomach#, and severe lower esophageal
inflammation. The scope cannot pass into the duodenum. Also, the ERCP cannula
and guidewire cannot move into the duodenum. Also, an amount of water was
injected into the pyloric area, and the endoscopist observes if this water pass
or not into the duodenum (water challenge test#).
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