I'm carrying out a dilatation (20mm) of a distal gastric stricture.
WHAT IS THE LIKELY AETIOLOGY OF THE STRICTURE?
■ Benign pyloric stricture
But the stricture is pre-pyloric!
■ Anastomotic stricture
Doesn't look like an anastomosis!
■ Radiotherapy stricture
But why giving radiotherapy to the stomach?
The mucosa in the 4 o'clock position looks pale and atrophic. This is a 'scar' left after treatment of a gastric lymphoma. Of course, the scar would look the same following Hp eradication of a MALT lymphoma. However, this was after following chemoradiotherapy (CRT) for a 'Diffuse large B-cell lymphoma. Which is a far more nasty lymphoma and patients present with more advanced stage at diagnosis, and have a worse prognosis (about 75% of patients are alive at 5 yrs) than with a MALT lymphoma.
This patient was treated with 6 cycles of R-CHOP chemotherapy and radiotherapy 30 Gy in 15 fractions. The risk of stricturing after gastric CRT is around 5%. My dilatations to 20mm didn't do much and the patient had to come back for a dilatation to 25mm before symptoms improved.