A 41-year-old man diagnosed with a moderately differentiated adenocarcinoma implanted on short segment Barrett's oesophagus, detected during routine endoscopy carried out in the context of a long-standing gastro-oesophageal reflux disease.
The patient underwent surgery, with total transhiatal oesophagectomy with cervical anastomosis, creating a tubulised gastric conduit, associated with vagotomy, without pyloroplasty. Postoperatively, the patient presented with copious and persistent vomiting that did not improve after a week of conservative treatment, including metoclopramide and i.v. erythromycin.
Oral endoscopy demonstrated abundant retention in the gastric conduit and a markedly stenosed pylorus. Pyloric dilatation with an 18 mm balloon (CRE™ Wireguided Balloon Dilator; Boston Scientific Corporation) was performed, followed by easy passage of a 10 mm gastroscope through the pyloric channel. However, after a few days, the patient did not experience any improvement. A barium study revealed an almost complete and persistent stop in the pylorus, allowing only a filiform passage of contrast.

One week after dilatation, a new pyloric dilatation, in this case forced, was performed with a 35 mm balloon (Rigiflex®; Microvasive, Boston Scientific, USA), with the patient's informed consent. The procedure was performed under deep sedation, with anaesthetist, endoscopic and fluoroscopic control. The endoscope was advanced into the descending duodenum, leaving a radio-opaque guide. The pylorus was marked by submucosal contrast injections at several points. With the endoscope withdrawn, the balloon was advanced over the guidewire until it was correctly positioned, under fluoroscopic control. At that point, the balloon was inflated with air at 300 mmHg, with manometric control, to 300 mmHg for two minutes. After the procedure, the pylorus was widely dilated. After dilatation, plain abdominal radiology was performed and the patient was monitored for signs and symptoms of perforation or bleeding. No complications occurred. The patient was able to drink fluids without problems after 24 hours. In the following days, progressive oral tolerance was satisfactory. A new radiological control with barium showed good passage of contrast into the duodenum. The patient was discharged a few days later and is asymptomatic 3 months later.