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Figure legends
Fig. 1. a) Stenosis was defined as a condition in which an endoscope could not pass
from the antrum to the duodenum. b) Deformation was defined as a condition in which
a large luminal curvature was shown by esophagogastroduodenoscopy, resulting in
gastric stasis, but the endoscope could pass from the antrum to the duodenum.
Fig. 2. a) We performed endoscopic submucosal dissection (ESD) in the lower part of
the stomach so that the circumferential mucosal defect was greater than 3/4. The
mucosal defect was beyond the angular region but not on the pyloric ring. b) During the
healing process of the artificial ulcer, the antrum was deformed and the pyloric ring
could not be seen. A large amount of food residue remained in the stomach. c) We
performed additional ESD on the greater curvature in the antrum, which was
contralateral to the post-ESD site. d) The deformation was gradually released by the
contralateral traction that occurred during improvement of the new artificial ulcer. We
could observe the gastric lumen in the antrum.
Fig. 3. The flow chart of patients and lesions included in this study.
Table 1. Characteristics of 41 cases
Age
74（68-80)
Gender
Male
28
Female
13
Pyloric dissection
26
Angular dissection
11
Location
Lesser curve
26
Greater curve
Anterior wall
Posterior wall
Circumferential extent of mucosal defect, %
86 (83-95)
macroscopic type
elevated
28
depressed
13
invasion depth
mucosal
36
submucosal
Ulcer findings
10
Specimen diameter (mm)
60
Use of steroids
11
Deformation
Stenosis
36
Perforation by EBD
Data represents the number of patients or median (interquartile range)
EBD: Endoscopic balloon dilation
Table 2. Comparison of deformation and non-deformation (stenosis) cases
Age, years
Deformation (+)
Deformation (-)
n=5
n=34
69 (68-75)
p-value
74 (68-83)
Gender
0.64
female
11
male
25
Pyloric dissection
0.004
present
26
absent
10
Angular dissection
<0.001
present
absent
30
Location
0.63
Lesser curve
21
Greater curve
Anterior wall
Posterior wall
84 (83-90)
86 (82-95)
Circumferential extent of
mucosal defect (%)
0.34
Macroscopic type
0.79
0.30
elevated
26
depressed
10
Invasion depth
mucosal
31
submucosal
Ulcer findings
0.58
present
absent
28
Specimen diameter (mm)
110 (102-113)
57 (45-68)
Use of steroid
0.003
present
10
absent
26
Data represents the number of patients or median (interquartile range)
Table 3. Deformation cases depending on dissection range
Dissection range
Deformation rate
Angular dissection (+), Pyloric dissection (-)
63% (5/8)
Angular dissection (+), Pyloric dissection (+)
0% (0/3)
Angular dissection (-), Pyloric dissection (-)
0% (0/7)
Angular dissection (-), Pyloric dissection (+)
0% (0/23)
Data represents rate (Number of deformation cases/ Number of all cases)
Table 4. Characteristics of five cases with deformation
Specimen
No
diameter
(mm)
Circumferential
extent of the
mucosal defect
(%)
Number of
EBDs
(number)
Maximum
Diameter
of EBDs
(mm)
Period
Period from
from ESD
ESD to
to gastric
additional
stasis
treatment (day)
Additional
treatment
(day)
128
83
18
25
91
Distal gastrectomy
63
84
20
27
71
Distal gastrectomy
113
95
20
48
78
Gastrojejunostomy
102
90
14
20
41
125
EAP
102
83
20
46
157
EAP
EBD: Endoscopic balloon dilation, ESD: endoscopic submucosal dissection, EAP:
Endoscopic antralplasty
...
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