A 41-year-old male diagnosed with moderately differentiated adenocarcinoma implanted on short segment gastroesophageal reflux disease detected by routine endoscopy because of a long-standing reflux disease.
The patient underwent surgery, performing a total transhiatal anastomosis associated with cervical anastomosis, creating a tubulated gastric duct, vagotomy without pyloroplasty.
Postoperatively, the patient developed copious and persistent vomiting that did not improve after one week of conservative treatment, including metoclopramide and persistent fever iv.
Oral endoscopy showed abundant retention in the gastric duct and a markedly stenosed pylorus.
An 18 mm balloon pyloric dilatation was performed (CRETM Wire-guided Balloon Dilator; Boston Scientific Corporation), followed by an easy 10 mm gastrocnemius channel.
However, after a few days, the patient did not experience any improvement after that.
A barium study revealed an almost complete and persistent stop in the pylorus, allowing only a Pathiform of Contrast.
1.
A week after dilation, a new dilation of the pylorus was performed, in this case forced, with a 35 mm balloon (Rigiflex®; Microvasive, Boston Scientific, USA.
U.S.), prior informed consent from the patient.
The procedure was performed under deep sedation, with an anesthesiologist, and endoscopic and fluoroscopic control.
The patient progressed with the guide wire to the descending duodenum leaving a radio-opaque guide.
The pylorus was marked by injections of submucosal contrast at various points.
Once the end was removed, the balloon was advanced over the guidewire until it was properly positioned under fluoroscopic control.
At this point, the balloon was swollen with air at 300 mmHg, with manometric control at 300 mmHg for two minutes.
After the procedure, the pylorus was widely dilated.
After dilation, a simple abdominal X-ray was performed and the patient was monitored to rule out signs and symptoms of perforation or bleeding.
There were no complications.
The patient was able to drink clear liquids 24 hours later.
In the following days, progressive oral tolerance was satisfactory.
A new radiological control with barium showed good passage of contrast to the duodenum.
The patient was discharged a few days later and is asymptomatic 3 months later.
