Laparoscopically assisted distal gastrectomy with Billroth I anastomosis for refractory gastric outlet obstruction after endoscopic submucosal dissection procedure: a case report

Endoscopic submucosal dissection (ESD) has become the standard minimally invasive treatment for early gastric cancer and precancerous lesions. However, performing extensive resections near the pyloric ring or antrum may lead to post-ESD gastric outlet obstruction (GOO) due to scar-related stenosis and luminal deformation. This report presents a case of a 62-year-old female patient who developed severe GOO after ESD treatment for a poorly differentiated antral adenocarcinoma (pT1aN0M0). Initial interventions involved two endoscopic balloon dilations at the pyloric stricture, which failed to provide lasting relief of symptoms. Subsequently, a salvage treatment was performed with laparoscopic-assisted distal gastrectomy with Billroth I reconstruction, resulting in complete resolution of obstruction symptoms and restoration of normal oral intake. This case highlights the challenges in managing post-ESD GOO and demonstrates that laparoscopic-assisted distal gastrectomy with Billroth I reconstruction is an effective salvage option for refractory cases. Further studies are needed to optimize treatment strategies and evaluate long-term outcomes.