Neoplastic gastric outflow tract obstruction relieved at endoscopy by argon laser

Abstract

In 1981, a 71-year-old man was admitted because of a 4month history of progressive gastric retention, rapid satiety, and regurgitation of partly digested foods culminating in a total inability to keep liquids down. Nine years earlier a Polya partial gastrectomy had been performed to remove an antral adenocarcinoma. Barium studies on admission revealed a tight 3-mm stenosis of the stomal outflow tract. Endoscopy and biopsy showed extensive infiltration of the gastric remnant by recurrent adenocarcinoma to within 2 em of the cardioesophageal junction. The stomal orifice was narrowed and was blocked off by a nodule of tumor that appeared to produce a ball valve effect. Clinical evidence of hepatic metastases, the presence of ascites, the extent of the primary tumor, and a previous hemiparesis ruled out surgery. Endoscopic laser treatment was undertaken since no alternative endoscopic means of relieving this obstruction was available. Following treatment this patient was able to swallow liquids and minced solids and became well enough to return home. A repeat barium meal showed that good relief of the obstruction had been achieved with an increase in stomal diameter to 10 mm. Barium passed on the first swallow into both afferent and efferent loops of the jejunum. This improvement was maintained when the barium study was repeated 3 months later. Endoscopic views of the gastric outflow tract at presentation and at the end of the last treatment session are shown in Figures 1 and 2. This patient died of pneumonia 4 months after treatment but was able to swallow liquids and solids even during his final admission.