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Endoscopy showed a tight distal antral stricture with pyloric obstruction despite prior dilation. The patient underwent circumferential endoscopic incisional therapy using an insulated tip nano-electrosurgical knife, followed by contrast leak assessment and wire-guided balloon dilation to allow gastroscope passage. Intramuscular steroid injections were then administered in four quadrants, with symptom resolution one month later.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/endoscopic-stricturoplasty-for-pyloric-stenosis-refractory-to-endoscopic-balloon-dilation-and-lumen-apposing-metal-stenting-case-report/459162/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/endoscopic-stricturoplasty-for-pyloric-stenosis-refractory-to-endoscopic-balloon-dilation-and-lumen-apposing-metal-stenting-case-report/459162.png","ImageObject",300,407,{"name":92,"@type":93},"moss~","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-08","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":19},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why was endoscopic stricturoplasty considered in this case?","Question",{"text":112,"@type":113},"The patient developed symptomatic recurrent pyloric stenosis despite prior endoscopic balloon dilation and AXIOS lumen apposing metal stent placement, with endoscopy showing a tight distal antral stricture and failed gastroscope passage.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What procedures were performed during endoscopic management?",{"text":117,"@type":113},"Circumferential stricturoplasty using an insulated tip nano-electrosurgical knife was performed, followed by wire-guided balloon dilation (13.5–15.5 mm) after contrast leak absence, enabling gastroscope passage; intramuscular steroid injections were then administered in four quadrants.",{"name":119,"@type":110,"acceptedAnswer":120},"What was the short-term outcome after treatment?",{"text":121,"@type":113},"One month after endoscopic incisional therapy, the patient reported resolution of symptoms.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},459162,1790755314,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":19,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":129,"read_time":24,"preview_page_count":4},962090895452,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","Article published online: 2026-01-08  \nEndoscopic stricturoplasty for pyloric stenosis refractory to endoscopic balloon dilation and lumen apposing metal stenting  \n▶Fig. 1 Abb. An endoscopic image of a tight stricture in the distal antrum with associated pyloric stenosis.  \n▶Fig.4 An endoscopic image depicting  \n13.5–15.5mm wire-guided endoscopic balloon dilation (EBD) of the pylorus.  \nWe present a case of a 67-year-old woman with a pertinent past medical history of benign, high-grade pyloric stenosis status after endoscopic balloon dilation (EBD)×3 and an AXIOS (Boston Scientific, Marlborough, MA, USA) lumen apposing metal stent (LAMS)×2 who presented for the endoscopic management of symptomatic, recurrent pyloric stenosis. Despite the AXIOS LAMS and EBD therapy, 22-and 7-months prior (respectively), she developed symptomatic recurrence. Esophagogastroduodenoscopy revealed a tight stricture in the distal antrum with associated pyloric stenosis ( ▶ Fig.1) that pre-  \n▶Fig.2 An endoscopic image depicting insulated tip nano-electrosurgical knife stricturoplasty (ITNKS) in a 3-, 6-, 9-and 12-o ’clock or circumferential fashion (black arrows) .  \n▶Fig.5 A fluoroscopic image depicting the advancement of the gastroscope into the duodenum status post ITNKS. ITNKS, insulated tip nano-electrosurgical knife stricturoplasty.  \ncluded gastroscope passage despite 11– 13mm wire-guided EBD. She underwent endoscopic incisional therapy (EIT) via circumferential stricturoplasty (▶ Fig.2 ,▶ Fig.3) with an Olympus (Center Valley, PA, USA) insulated tip nano-electrosurgical knife (ITNK) . Upon contrast leak absence, 13.5–15.5mm wire-guided EBD ( ▶ Fig.4) was performed which allowed for gastroscope passage ( ▶ Fig.5) . Intramuscular steroid injections were  \n▶Fig.3 An endoscopic image of the pylorus status post-ITNKS revealing extensive underlying fibrotic tissue. ITNKS, insulated tip nano-electrosurgical knife stricturoplasty.  \nVideo 1 Treatment of symptomatic, recurrent pyloric stenosis refractory to endoscopic balloon dilation and lumen apposing metal stent deployment via insulated tip nano-electrosurgical knife stricturoplasty.  \nthen performed in the four quadrants of the pylorus. One-month post-EIT, she reported resolution of her symptoms. Initial therapy in the management of gastrointestinal strictures typically involves EBD, especially in patients with inflammatory bowel disease [1,2] and benign pyloric strictures [3,4] . Several sessions of EBD are often required to achieve luminal patency, and strictures can persist/recur despite EBD entailing alter-  \nRozenberg Jonathan et al. Endoscopic stricturoplasty for… Endoscopy 2026; 58: E1–E2 | © 2026. The Author(s) . E1  \nnative treatment modalities [1,3,5] . In these cases – namely benign pyloric strictures – LAMS deployment can prove beneficial as it provides sustained dilation [4]; however, there is a risk of stricture recurrence after LAMS removal. Owing to the possibility of complications (e. g. , perforation and stent migration), minimally invasive incisional endoscopic techniques such as ITNK stricturoplasty (ITNKS) have been utilized in the management of benign pyloric strictures with favorable but limited results [3–5] . Furthermore, its application in cases that have failed EBD and LAMS therapy are extremely scarce. As such, this case depicts the successful treatment of a pyloric stricture refractory to standard therapy via endoscopic ITNKS ( ▶Video 1) .  \nEndoscopy_UCTN_Code_TTT_ 1AO_ 2AH  \nContributors ʼ Statement  \nJonathan Rozenberg: Data curation, Writing – original draft, Writing – review & editing. Rohit Kumar: Data curation, Writing – review & editing. William F. Abel: Data curation, Writing – review & editing. Joel Joseph: Visualization, Writing – review & editing. Vivek Kesar: Visualization, Writing – review & editing. Patrick Okolo: Visualization, Writing – review & editing. Varun Kesar: Conceptualization, Supervision, Validation, Visualization, Writing – review & editing","cbCais8lBBTKfAuB","https://ap.wps.com/l/cbCais8lBBTKfAuB","pdf",2833207,"English","# Case presentation\n## Endoscopic incisional therapy and follow-up\n## Background on EBD, LAMS, and stricturoplasty","[{\"question\":\"Why was endoscopic stricturoplasty considered in this case?\",\"answer\":\"The patient developed symptomatic recurrent pyloric stenosis despite prior endoscopic balloon dilation and AXIOS lumen apposing metal stent placement, with endoscopy showing a tight distal antral stricture and failed gastroscope passage.\"},{\"question\":\"What procedures were performed during endoscopic management?\",\"answer\":\"Circumferential stricturoplasty using an insulated tip nano-electrosurgical knife was performed, followed by wire-guided balloon dilation (13.5–15.5 mm) after contrast leak absence, enabling gastroscope passage; intramuscular steroid injections were then administered in four quadrants.\"},{\"question\":\"What was the short-term outcome after treatment?\",\"answer\":\"One month after endoscopic incisional therapy, the patient reported resolution of symptoms.\"}]","Endoscopic stricturoplasty for pyloric stenosis refractory to endoscopic balloon dilation and lumen apposing metal stenting - case report | PDF"]