A CASE OF RESIDUAL EARLY GASTRIC CANCER COMPLICATED BY BALL VALVE SYNDROME RESECTED USING THE ENDOSCOPIC SUBMUCOSAL DISSECTION TECHNIQUE

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A 83-year-old man who had undergone endoscopic mucosal resection (EMR) for gastric cancer 35 month previously was admitted to our hospital complaining of sudden epigastric pain and vomiting. Abdominal computed tomography showed a large tumor in the duodenum. Esophagogastroduodenoscopy (EGD) showed drawn folds from the gastric body into pyloric side, and no tumor was seen in the stomach. After pushing the scope gently, a good view was obtained with EGD which showed fresh blood in the duodenal bulb. When the endoscope was returned to the stomach, a type 0-I protrusion of about 30 mm had appeared in the anterior wall of the middle stomach. The diagnosis of early gastric cancer complicated by ball valve syndrome (BVS) was made. Endoscopic submucosal dissection (ESD) was chosen because of bleeding and fibrosis and we were able to perform an en-bloc resection with no complications. Histological examination revealed papillary and tubular adenocarcinoma with an invasion depth of pT1b1 (SM 300 μm). Vascular permeation was positive (V1) and moderate fibrosis was noted in the submucosal layer. Only 5 cases have been reported including our case in which gastric cancer complicated with BVS was resected endoscopically.