#Remnant gastric
carcinoma#
A 68-year-old man presented with dysphagia was admitted to
the gastroenterology unit. The patient gives a history of operated gastric
cancer 3 years ago (partial gastrectomy mostly involving the fundus, body, and
pylorus). The patient had received chemotherapy and radiotherapy. Also, the
patient received target therapy and immunotherapy but, without improvement. The
most recent pet CT showed an active tumor in the remaining gastric portion. The
patient was advised by his oncologist to undergo upper digestive endoscopy for
stent insertion to overcome the obstruction made by the tumor. The patient underwent
upper GI endoscopy. The scope showed about 8cm gastric mass that nearly
occupying the stomach lumen, besides, the mass easily bleeds on touch. This
mass extends to the lower esophagus with a remnant of food in the stomach and
lower esophagus. Also, lower esophagus inflammation was detected. Duodenal examination
revealed a common pathway extending from the stomach but, after 3 to 4 cm this
common pathway is divided into 2 pathways as shown in this video. A safari guidewire
was inserted and a partially covered esophageal stent (13 cm long) was deployed
into the duodenum (2 cm inside the duodenal lumen) all over the stomach lumen
and up to 3 cm inside the esophageal lumen (oral end of the stent).
N.B.
1-To make sure that the distal end of the stent is inserted appropriately
into the duodenum this step was done under direct visualization by the endoscope,
also the cephalad end of the stent with the help of the fluoroscopy.
2-you can notice that the introduction of the scope into the
duodenum is difficult due to the previous operation and the remnant gastric
cancer, the endoscopist make an upward movement to get into the duodenum
Questions
Do you think that the esophageal stent is the best option
for this patient? What about the gastric mega stent?
Is it dysphagia alone or dysphagia and gastroparesis?
What was the type of operation done 3 years ago?
Is the opening between the stomach and duodenum the true
pyloric ring or a postoperative one?
Comments