Table 1.
Patients’ demographics for the initial 47 and final 45 patients.
Fig 1.
A flow diagram of our study population.
Fig 2.
Images of a 60-year-old woman with impaired pyloric function after laparoscopy-assisted pylorus-preserving gastrectomy (PPG).
(A) On the scout image obtained 13 days after PPG, approximately 1/2~3/4 of the stomach (S) is filled with residual food material, resulting in a semi-quantitative score for residual food of 2. (B) On upper gastrointestinal series (UGIS), the pyloric canal is severely narrowed (arrow) and the width of the pyloric canal and the height of the adjacent vertebral body are 1.5 and 24.87, respectively, with a pyloric canal-to-height of vertebral body ratio of 6.03. A = antrum, D = duodenum. (C), (D) Fluoroscopic images show dilatation of the stenotic pyloric canal with a 25 mm x 4 cm long balloon until the balloon deformity disappears. (E) The scout image of UGIS obtained 11 months after balloon dilatation shows no residual food material within the stomach, resulting in a markedly improved semi-quantitative score for residual food of 5. (F) UGIS shows a dilated pyloric canal (arrow), and the width of the pyloric canal and the height of the adjacent vertebral body are 11.33 and 27.71, respectively. Therefore, the pyloric canal-to-height of vertebral body ratio was also markedly increased to 40.89. Finally, her subjective symptom score of post-prandial discomfort was also markedly decreased from 10 to 3 after the balloon procedure.
Fig 3.
Images of a 68-year-old woman with impaired pyloric function after laparoscopy-assisted pylorus-preserving gastrectomy (PPG).
She underwent balloon dilatation with a 22 mm x 4 cm long balloon 3 times for 3 minutes with a 1-minute interval 19 days after PPG. (A) Post-ballooning upper gastrointestinal series (UGIS) shows tight stenosis of the pyloric canal (arrow) due to recoil of the stenosis. The pyloric canal-to-height of vertebral body ratio was 3.7. (B) Stent insertion was done for pyloric spasms with a 20 mm x 10 cm long fully covered retrievable stent. Fluoroscopic image shows good passage of the contrast agent to the duodenum (D). Stent removal was successfully done 2 weeks after stent insertion. (C) On the scout UGIS obtained 3 months after stent removal, approximately 1/4~1/2 of the stomach (S) is filled with residual food material, resulting in a semi-quantitative score for residual food of 3. (D) UGIS shows a dilated pyloric canal (arrow) and the width of the pyloric canal and the height of the adjacent vertebral body are 9.39 and 27.62, respectively. Therefore, the pyloric canal-to-height of vertebral body ratio was markedly increased from 3.7 to 34.0. Finally, her subjective symptom score for post-prandial discomfort was also markedly resolved from 10 to 3 after the stent procedure.
Fig 4.
Images of a 56-year-old man with impaired pyloric function after laparoscopy-assisted pylorus-preserving gastrectomy (PPG).
The patient underwent balloon dilatation and subsequent stent insertion 21 and 23 days after PPG, respectively. (A) On the scout image obtained after stent insertion, the stent (arrowheads) is well placed extending from the stomach (S) to the duodenum (D) with its center located at the pyloric canal. (B) On plain abdominal radiograph obtained after 1 day, the stent (arrowheads) has migrated proximally and is located within the remnant stomach. (C) Fluoroscopic guided stent removal was done using an angiographic catheter (arrows). Note the collapsed proximal end (arrowhead) of the stent.
Fig 5.
Semi-quantitative grading for the degree of residual food stagnation within the remnant stomach.
Grade 1 is defined as when more than 3/4 of the remnant stomach is filled with residual food; grade 2 when 3/4 ~ 1/2 of the residual stomach is filled; grade 3 when 1/2 ~ 1/4 of the residual stomach is filled; grade 4 when less than 1/4 of the residual stomach is filled; grade 5 when the entire stomach is empty on the scout image of the upper gastrointestinal series.
Table 2.
Results of Univariate Statistical Analysis between Balloon and Stent Groups.
Table 3.
Number of Patients according to Follow-up Period in Each Group.
Fig 6.
Graphs showing the results of subjective and objective analyses in the balloon group.
(A) Plotting of subjective symptom scores before and after balloon dilatation. In all patients, subjective symptom scores improved after balloon dilatation. (B) Plotting of the pyloric canal-to-height of vertebral body ratio before and after balloon dilatation. In all patients except one (arrow), the pyloric canal-to-height of vertebral body ratio increased after balloon dilatation. (C) Plotting of the grade for residual food stagnation before and after balloon dilatation. In 26 of 33 patients, the grade of residual food stagnation improved. The grade of residual food stagnation was the same after balloon dilatation in four patients (arrows) (2 to 2 in three and 1 to 1 in one) and became worse in the remaining three (arrowheads) (2 to 1, 3 to 2, and 4 to 2).
Fig 7.
Graphs showing the results of subjective and objective analyses in the stent group.
(A) Plotting of subjective symptom scores before and after balloon dilatation and after stent insertion. In all patients, subjective symptom scores were not improved after balloon dilatation. However, it was significantly improved after stent insertion. (B) Plotting of the pyloric canal-to-height of vertebral body ratio before and after balloon dilatation and after stent insertion. In all patients, the ratio of the pyloric canal-to-height of the vertebral body increased after stent insertion compared to both before and after balloon dilatation. (C) Plotting of the grade for residual food stagnation before and after balloon dilatation and after stent insertion. In all patients, the grade of residual food stagnation improved after stent insertion compared to both before and after balloon dilatation.