Clinical utility of the 2016 ASE/EACVI recommendations for the evaluation of left ventricular diastolic function in the stratification of post-discharge prognosis in patients with acute heart failure.

AIMS: Left ventricular diastolic dysfunction (LVDD) has prognostic significance in heart failure (HF). We aimed to assess the impact of LVDD grade stratified by the updated 2016 echocardiographic algorithm (DD2016) on post-discharge outcomes in patients admitted for acute HF and compare with the previous 2009 algorithm (DD2009). METHODS AND RESULTS: The study included 481 patients hospitalized for acute decompensated HF. Comprehensive echocardiography and LVDD evaluation were performed just before hospital discharge. The primary endpoint was a composite of cardiovascular death and readmission for HF. The concordance between DD2016 and DD2009 was moderate (κ = 0.44, P < 0.001); the reclassification rate was 39%. During the follow-up (median: 15 months), 127 (26%) patients experienced the primary endpoint. In the Kaplan-Meier analysis, Grade III in DD2016 showed a lower event-free survival rate than Grades I and II (log rank, P < 0.001 and P = 0.048, respectively) and was independently associated with a higher incidence of the primary endpoint than Grade I [hazard ratio 1.89; 95% confidence interval (CI) 1.17-3.04; P = 0.009]. Grade II or III in DD2016, reflecting elevation of left ventricular (LV) filling pressure, added an incremental predictive value of the primary endpoint to clinical variables irrespective of LV ejection fraction. DD2016 was comparable to DD2009 in predicting the endpoint (net reclassification improvement = 11%; 95% CI -7% to 30%, P = 0.23). CONCLUSION: Despite simplification of the algorithm for LVDD evaluation, the prognostic value of DD2016 for post-discharge cardiovascular events in HF patients was maintained and not compromised in comparison with DD2009.

Incremental Prognostic Value of Right Ventricular Strain in Patients With Acute Decompensated Heart Failure.

BACKGROUND: Although 2-dimensional strain analyses based on speckle tracking echocardiography have been used to detect myocardial deformation, the prognostic impact of 2-dimensional strain is unclear in patients with acute decompensated heart failure (HF). We investigated whether left ventricular and right ventricular (RV) strain parameters assessed by speckle tracking echocardiography provide incremental prognostic information in hospitalized patients because of acute decompensated HF. METHODS AND RESULTS: Six hundred eighteen patients (age, 72±13 years; 38% women; ejection fraction, 46±16%) hospitalized for acute decompensated HF underwent clinical and echocardiographic evaluation just before discharge. We performed strain analyses of left ventricular global longitudinal strain and left ventricular global circumferential strain. We also analyzed RV longitudinal strain only from the free wall (RV-fwLS) and from all segments of the RV global longitudinal strain wall by using Tomtec software. The primary composite end point was cardiovascular death and readmission for HF. There were 34.8% cardiac events during a median follow-up of 427 days. In multivariate Cox models, among echocardiographic parameters, only impaired RV-fwLS (≥-13.1%; hazard ratio, 1.51; 95% CI, 1.12-2.04; P=0.01) was independently associated with cardiac events. Adding RV-fwLS to clinical risk evaluation (age, New York Heart Association class III/IV, blood urea nitrogen, and brain natriuretic peptide) markedly improved prognostic utility and consequently increased net reclassification improvement by 0.30 ( P=0.01). CONCLUSIONS: RV-fwLS is an independent predictor of cardiac events in acute decompensated HF and provides greater prognostic power than standard echocardiographic parameters.

Hypertensive crisis during catheter ablation of atrial fibrillation in a patient with undiagnosed pheochromocytoma: a case report.

INTRODUCTION: Pheochromocytoma is an unusual cause of hypertension accounting for 0.1% of cases. As the development of atrial fibrillation (AF) is tightly associated with hypertension, patients with pheochromocytoma are at higher risk for AF. CASE PRESENTATION: A 72-year-old woman with undiagnosed pheochromocytoma underwent catheter ablation of drug-resistant AF. Procedure-related external factors, such as prescription of a beta blocker without the preventive administration of an alpha blocker, use of contrast medium, administration of anaesthetics, and emotional and pain-related stress, caused a hypertensive crisis with acute left ventricular dysfunction during ablation procedure. After surgical resection of the adrenal tumour, sinus rhythm was maintained without antiarrhythmic drugs. DISCUSSION: Because hypertensive crisis can lead to life-threatening organ damage, electrophysiologists seeing patients with AF should always consider pheochromocytoma as a mechanism of hypertension and AF before proceeding to catheter ablation of the AF.

Incremental value of B-type natriuretic peptide for detection and risk reclassification of obstructive coronary artery disease on computed tomography angiography.

BACKGROUND: B-type natriuretic peptide (BNP) is well known to increase as a result of left ventricular systolic dysfunction and is a useful diagnostic marker for heart failure. The purpose of this study was to assess the incremental value of BNP for predicting obstructive coronary artery disease (CAD) on computed tomography angiography (CTA) in patients with suspected CAD. METHODS: This was an observational analysis of patients with stable CAD undergoing CTA in our institution between April 2008 and June 2014. Consecutive 947 patients with suspected CAD who underwent 64-slice CTA were enrolled. Obstructive CAD was defined as more than 50% luminal narrowing. We divided the patients into 2 groups according to median BNP value (20.3pg/ml). Duke clinical score for obstructive CAD was calculated for each patient. RESULTS: Obstructive CAD was found in 273 (28.0%) patients. Median follow-up period was 37 months (interquartile range 21-55 months). Kaplan-Meier curves showed that BNP above median was significantly associated with major adverse cardiac events (p=0.001). In multivariable logistic analysis, patients with BNP above median were associated with the presence of obstructive CAD, as compared with BNP below median [odds ratio, 2.55; 95% confidence interval (CI), 1.79-3.63; p<0.001]. Analyzing the incremental value of the Duke clinical score and BNP, the predictive value of the Duke clinical score [area under the curve (AUC), 0.714] could be increased by BNP (AUC 0.745 for the combined model; p<0.001). Addition of BNP to a model containing the Duke clinical score resulted in net reclassification improvement index of 0.14 (95% CI: 0.053-0.205, p<0.001). CONCLUSIONS: BNP might provide an incremental improvement in the detection of obstructive CAD on CTA when combined with a conventional cardiovascular risk score.

Changes of gene expression of thymidine phosphorylase, thymidylate synthase, dihydropyrimidine dehydrogenase after the administration of 5'-deoxy-5-fluorouridine, paclitaxel and its combination in human gastric cancer xenografts.

BACKGROUND: Although a variety of combination chemotherapies has been tested in gastric carcinoma, the most effective chemotherapeutic regimen and the precise mechanisms underlying anticancer agent combination have not yet been sufficiently elucidated. MATERIALS AND METHODS: Experimental chemotherapy was performed using human gastric carcinoma xenografts, MKN-45 and TMK-1, to examine the anticancer effects and gene expressions of the enzymes involved in 5-fluorouracil metabolism, thymidine phosphorylase (dThdPase), thymidylate synthase (TS) and dihydropyrimidine dehydrogenase (DPD). Nude mice were treated with 5'-deoxy-5-fluorouridine (5'-dFUrd), or paclitaxel alone or in combination. The in vivo antitumor effects on gene expressions of the enzymes were examined using the quantitative real-time RT-PCR method. RESULTS: The combined use of 5'-dFUrd and paclitaxel showed additive to synergistic antitumor effects on both gastric cancer xenografts. There were significant differences of the gene expressions of dThdPase, TS, and DPD between the xenografts. The expression of dThdPase mRNA was consistently up-regulated by the administration of paclitaxel, while no constant direction of TS mRNA and DPD mRNA change was found in the xenografts. CONCLUSION: A synergistic antitumor effect of the combined administration of 5'-dFUrd and paclitaxel was found in gastric cancer xenografts and up-regulation of dThdPase mRNA may be an important underlying mechanism especially in tumors with high gene expression of this enzyme.

Effects of combined administration of DPD-inhibitory oral fluoropyrimidine, S-1, plus paclitaxel on gene expressions of fluoropyrimidine metabolism-related enzymes in human gastric xenografts.

BACKGROUND: S-1 is the most effective oral fluoropyrimidine derivative widely used for patients with gastric carcinoma in Japan. Although S-1 plus taxane has been a promising candidate as an effective chemotherapeutic regimen, the mechanisms of its additive or synergistic anticancer effects and changes in gene expression after the administration of these agents have not yet been fully elucidated. METHODS: Experimental chemotherapy was performed using human gastric carcinoma xenografts, MKN-45 and TMK-1, to examine anticancer effects and gene expressions of fluoropyrimidine metabolism-related enzymes including thymidine phosphorylase (TP), thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD), orotate phosphoribosyltransferase (OPRT), and uridine phosphorylase (UP). Nude mice were treated with S-1, paclitaxel, and their combination. After treatment, in vivo antitumor effects of S-1, paclitaxel alone, and their combination and the effects on gene expressions of enzymes involved in 5-fluorouracil metabolism were examined using the RT-PCR method. RESULTS: The combined use of S-1 and paclitaxel showed additive to synergistic antitumor effects on both gastric cancer xenografts. While consistent upregulation of dThPase and DPD gene expression was exhibited after administration of S-1, no further increase of dThPase gene expression after combined use of S-1 with paclitaxel was observed. There was no increase in TS gene expression after the administration of either S-1 alone or paclitaxel alone. CONCLUSION: These results provide some insight into the mechanism and/or rationale underlying the additive to synergistic effect of combined administration of S-1 and paclitaxel in gastric carcinoma.

Randomized clinical trial of the effects of perioperative use of immune-enhancing enteral formula on metabolic and immunological status in patients undergoing esophagectomy.

BACKGROUND: Although perioperative immune-enhancing enteral formula (IEEF) is effective to decrease the rate of infectious complications, it is not clear whether perioperative use of IEEF decreases the incidence of postoperative complications and improves clinical outcome in patients who have undergone esophagectomy. A prospective randomized clinical trial was performed to examine the effects of perioperative IEEF on nutritional and immunological status in patients with esophageal carcinoma who have been treated with esophagectomy. METHODS: A total of 30 patients were randomly assigned to two groups, each receiving 3 days of preoperative and postoperative enteral nutrition through jejunostomy started within 24 h after operation, either with immune-enhancing enteral formula (group IEEF, n = 16) or with regular polymeric enteral formula (group C, n = 14). Preoperative and postoperative nutritional and immunological parameters and clinical outcome were examined. RESULTS: A significant increase in the serum concentration of ornithine was noted in group IEEF and it peaked at 5 days after surgery. The equivalent values were significantly lower in group C. There was no difference in serum dochosahexaic acid between the two groups. The n-3/n-6 fatty acid ratio in group IEEF was significantly higher than in group C at 7 days after surgery. Peripheral percent lymphocyte fraction and total lymphocyte count in group IEEF were both significantly higher than those in group C. While T cell fraction of peripheral lymphocytes in group IEEF at 3 days after surgery, B cell fraction in group IEEF at 5 and 7 days after surgery was significantly higher than those in group C, suggesting that perioperative IEEF caused a shift towards B cell proliferation. CONCLUSIONS: Perioperative use of IEEF caused a significant increase in the total lymphocyte count at 3 and 5 days after operation and caused a shift toward B cell proliferation, which may possibly be beneficial to decrease the incidence of postoperative infectious complications.

[Clinical and prognostic significance of protein and gene expression of orotate phosphoribosyltransferase in gastric carcinoma].

Although orotate phosphoribosyltransferase (OPRT EC 2.4.2.10) is a key enzyme related to the first-step activation process of 5-fluorouracil, and therefore it has been shown to be an important enzyme that enables to predict sensitivity to 5-fluorouracil, the clinical and prognostic significance of protein and/or gene expression of OPRT has not been well established in gastric carcinoma. We examined the protein level, and mRNA expression of OPRT in gastric carcinoma tissues and relationships with clinicopathologic factors and prognosis were evaluated. A total of 75 surgically-resected gastric carcinoma tissues were subjected to the study. An enzymelinked immunosorbent assay (ELISA) was used to accurately assess intratumoral OPRT, and gene expressions of OPRT were examined using a real-time PCR method. Survival of patients with gastric carcinoma in relation to OPRT protein levels was analyzed using Kaplan-Meier methods along with log-rank test. The mean value of OPRT was 5.4+/-3.6 ng/mg protein, and it was significantly higher in patients with differentiated-type and invasive-type gastric carcinoma. The prognosis of patients in the high OPRT group was better than for those with low OPRT (p<0.05). There was a significant correlation between OPRT levels measured by ELISA and OPRT mRNA expression (p<0.05). Determination of OPRT levels is a useful tool to predict the biological characteristics of gastric carcinoma and possibly predict sensitivity to fluoropyrimidine-based anticancer chemotherapy,particularly dihydropyrimidine dehydrogenase-inhibitory fluoropyrimidine, in patients with gastric carcinoma.

Effects of long-term continuous use of immune-enhancing enteral formula on nutritional and immunologic status in non-surgical patients.

OBJECTIVE: Although the perioperative use of immune-enhancing enteral formula (IEEF) effectively reduces the rate of infectious complications, whether chronic use of IEEF is beneficial is unknown. A prospective randomized clinical trial was performed to examine the safety and effectiveness of long-term IEEF on nutritional and immunologic status in non-surgical patients receiving total enteral nutrition through the gastrostomy access route. METHODS: A total of 30 patients were randomly assigned to two groups in which they received total enteral nutrition, an IEEF (n = 15) or a regular polymeric enteral formula (control group; n = 15) for 12 wk. Nutritional and immunologic variables were periodically examined. RESULTS: Serum concentrations of insulin-like growth factor-I increased significantly for the IEEF group throughout the study. Although serum concentrations of dihomo-gamma-linoleic acid decreased significantly in the IEEF group, serum concentrations of eicosapentaenoic acid and docosahexaenoic acid increased significantly, as did concentrations of serum arginine and ornithine. The CD4/CD8 ratio and natural killer cell activity also increased for the IEEF group, but the differences were not significant. The B-cell fraction increased and the T-cell fraction of peripheral lymphocytes decreased for the IEEF group. Neither infectious nor non-infectious complications occurred during the study period in either group, except for a significant increase in serum urea nitrogen and uric acid concentrations for the IEEF group. CONCLUSION: Long-term use of IEEF is safe in non-surgical patients and results in a significant increase in serum insulin-like growth factor-I concentrations in association with increased humoral immunity.

Orotate phosphoribosyltransferase levels measured by a newly established enzyme-linked immunosorbent assay in gastric carcinoma.

A number of enzymes have been shown to be involved in the process of activation and/or degradation of 5-fluorouracil (5-FU), and are potential candidates for predicting chemosensitivity to 5-FU. Among these, orotate phosphoribosyltransferase (OPRT EC 2.4.2.10) is a key enzyme related to the first-step activation process of 5-FU and has been shown to be an important enzyme that helps to predict sensitivity to 5-FU and its related derivatives. We developed a new enzyme-linked immunosorbent assay (ELISA) to accurately assess intratumoral activity of OPRT. A new sandwich ELISA was established using anti-OPRT polyclonal antibodies obtained from the rabbit immunized with the recombinant human peptides of the OPRT molecule. OPRT levels were measured in eight human cancer xenografts and in 75 gastric cancer tissues using both a newly established ELISA and a conventional enzyme assay, using radiolabeled 5-FU as a substrate. There was a significant correlation between OPRT levels measured by this ELISA and OPRT enzyme activity the in eight human cancer xenografts (r2 = 0.782) and gastric carcinoma tissue (r2 = 0.617). The ELISA system for OPRT requires a minimal amount of carcinoma tissue, making it an easy-to-use assay system to predict sensitivity to 5-FU and its derivatives in gastric carcinoma. There was a significant correlation between tumor growth inhibition rates against the oral administration of oral-uracil/tegafur (UFT) and OPRT enzyme activity in the human cancer xenografts (r2 = 0.574). These results suggest that this newly developed sandwich ELISA system for the quantification of OPRT levels is technically simple, feasible and a useful tool to predict sensitivity to fluoropyrimidine-based anticancer chemotherapy in patients with gastric carcinoma and other cancers.

[Clinicopathological significance of orotate phosphoribosyltransferase in gastric carcinoma].

Orotate phosphoribosyltransferase (OPRT EC 2.4.2.10) is a key enzyme related to the first-step phosphorylation process of 5-fluorouracil. We have recently developed an ELISA system to measure OPRT levels in cancerous tissues. We examined OPRT levels in 75 gastric carcinoma tissues using this ELISA, and the relationships with clinicopathologic factors were evaluated. A total of 75 surgically-resected gastric carcinoma tissues were subjected to the present study. The intratumoral OPRT level was determined by a newly-developed enzyme-linked immunosorbent assay (ELISA). Enzyme activities of OPRT were also determined using a conventional enzyme assay using radiolabeled 5-fluorouracil as a substrate. OPRT levels in gastric carcinoma tissues measured by ELISA were 5.4+/-3.6 ng/mg protein, ranging from 0.2 to 15.7 ng/mg protein. There was a significant correlation between the OPRT level measured by the ELISA and OPRT enzyme activity (y=0.545x - 0.017, r(2)=0.617, p<0.0001). OPRT levels were significantly higher in patients with differentiated type and invasive type of gastric carcinoma, whereas OPRT levels were not associated with the pathological stage of gastric carcinoma. These results suggest that OPRT levels were related to the histopathological characteristics of gastric carcinoma, and may be related to the response to fluoropyrimidine-based anticancer chemotherapy.

Laparoscopy-assisted uncut Roux-en-Y operation after distal gastrectomy for gastric cancer.

In order to prevent the Roux stasis syndrome that sometimes follows Roux-en-Y gastrojejunostomy after distal gastrectomy, a new type of reconstruction, called the uncut Roux-en-Y technique, has been reported. We successfully performed 42 laparoscopy-assisted uncut Roux-en-Y gastrojejunostomies. Here we describe our technique and the initial outcome.

[Advancce in laparoscopic treatment for gastric cancer].

Many laparoscopic surgeries for gastric cancer are presented, including D 2 lymphadenectomy, gastrectomy with preservation of vagus nerve and intracorporeal anastomosis after some gastrectomies. The great advances in laparoscopic treatments in gastric cancer are described.

[Establishment of enzyme-linked immunosorbent assay for quantification of orotate phosphoribosyltransferase in gastric carcinoma].

A number of enzymes have been shown to be involved in the process of activation and/or degradation of 5-fluorouracil, and they are potential candidates for predicting factors of chemosensitivity to 5-fluorouracil. Among them, orotate phosphoribosyltransferase (OPRT EC 2.4.2.10) is a key enzyme related to the first-step activation process of 5-fluorouracil and therefore it has been shown to be an important enzyme for the prediction of sensitivity to 5-fluorouracil and its related derivatives. We developed a new enzyme-linked immunosorbent assay (ELISA) system to accurately assess intratumoral activity of orotate phosphoribosyltransferase. A new sandwich ELISA system was established using anti-OPRT polyclonal antibodies obtained from the rabbit immunized with the recombinant human peptides of the OPRT molecule. OPRT levels were measured in 8 human cancer xenografts transplanted in nude mice and 58 gastric cancer tissues using both a newly established ELISA and a conventional enzyme assay using radiolabeled 5-fluorouracil as a substrate. OPRT levels in 8 human cancer xenografts measured by this ELISA were significantly correlated with the OPRT enzyme activities (r2=0.782). Furthermore, OPRT activities measured in 58 gastric cancer tissues by enzyme assay were significantly correlated with those measured by the newly-established ELISA (r2=0.664). The ELISA system developed for the measurement of OPRT required a minimal amount of carcinoma tissue samples, which could be an easy-of-use assay system to predict sensitivity to 5-fluorouracil in gastric carcinoma. These results suggest that this newly-developed sandwich ELISA system for the quantification of OPRT is technically simple, feasible, and may be a useful tool to predict sensitivity to fluoropyrimidine-based anticancer chemotherapy in patients with gastric carcinoma and other cancers.

Abdominal wall abscess associated with perforated jejunal diverticulitis: report of a case.

We report a case of abdominal wall abscess caused by diverticulitis of the jejunum penetrating through the abdominal wall. A 53-year-old Japanese woman visited a local hospital complaining of abdominal pain and a mass in the left lower abdomen. An abdominal computed tomography scan showed a tumor with isodensity in the left lower abdominal wall. Magnetic resonance imaging showed a mass in the abdominal wall with isointensity in the T1-intensified image and high intensity in the T2-intensified images. The mass was heterogeneous inside and protruded partially toward the intraperitoneal cavity. Ultrasound examination showed a heteroechoic mass extending into the intraperitoneal cavity. Laparotomy revealed a tumor in the abdominal wall with a fistulous tract extending to the jejunum. We resected the abdominal wall tumor with partial resection of the small intestine. The resected specimen contained a tumor with a fistulous tract passing through the abdominal wall. Histological examination revealed remarkable infiltration of neutrophils and a bacterial mass in the abdominal wall tumor, with a fistulous tract connected to the area adjacent to the mesenteric border of the jejunum. These findings suggested that diverticulitis of the jejunum had penetrated through the abdominal wall, leading to the formation of an abscess. We report this case to highlight the need for complete gastrointestinal evaluation with gastrointestinal barium studies and imaging analysis to examine extension of intra-abdominal lesions in patients with an unexplained abdominal wall abscess.

Successful downstaging by S-1-based chemotherapy followed by surgical resections for gastric carcinoma with extensive distant lymph node metastasis - report of two cases and a review of cases with surgical resection after downstaging by S-1-based chemotherapy.

We report two cases of gastric carcinoma with successful downstaging using S-1-based chemotherapy followed by surgical resection, which enabled us to confirm the histological effect of chemotherapy. These patients were associated with extensive distant lymph node metastases for which curative resections were unlikely to be performed. We performed anticancer chemotherapy using S-1 with or without concomitant administration of cisplatin in a neoadjuvant setting. After the successful downstaging of these metastatic gastric carcinomas evaluated by imaging analyses, the patients underwent surgical resections. Effect of the chemotherapy was confirmed by the histological analyses. These cases provide further evidence, suggesting that S-1-based chemotherapy enabled downstaging of stage IV gastric carcinoma associated with distant extensive lymph node metastasis and consequently the following possible curative resections. The review of 16 cases of S-1-based chemotherapy followed by surgical resections indicated that, although downstaging may not be expected when N3 lymph node metastases are evident, the S-1-based chemotherapeutic regimens were effective in short cycles for patients in whom potential curative resection is expected. Survival benefit of downstaging followed by surgical resection, however, remains to be further elucidated.

[A case of Barrett's esophageal carcinoma successfully treated with TS-1 in an elderly patient].

A 92-year-old man was admitted to the hospital for rehabilitation. Upper gastrointestinal endoscopy was performed 2 weeks after admission because of vomiting which was found to be due to a Barrett's esophageal carcinoma at the lower esophagus. We chose chemotherapy with TS-1 at the dose of 50 mg/day in consideration of his age and performance status. His difficulty in swallowing disappeared rapidly. After 7 days of treatment, grade 3 anorexia appeared, so the dosage of TS-1 was reduced to 25 mg/day. After the reduction of TS-1, anorexia soon disappeared. The regimen consisted of TS-1 every 6 weeks as 1 cycle. After 7 cycles of treatment, upper gastrointestinal endoscopy and upper gastrointestinal series revealed that the tumor had a completely disappeared. The effects of chemotherapy were judged as CR. This case suggests that administration of TS-1 is an effective choice of chemotherapy not only for gastric carcinoma but also Barrett's esophageal carcinoma.

[Sustained NC status for a long period after combined chemotherapy of TS-1 and CDDP for residual lesions following gastrectomy for gastric cancer].

A 71-year-old man with nausea and epigastralgia was referred to our hospital and was diagnosed with type 3 gastric cancer. Palliative resection was performed since radical surgery was impossible due to massive tumorous invasion to the retroperitoneum. Chemotherapy with TS-1 100 mg p.o. was started for the residual cancer lesions, with CDDP i.v. 50 mg added from the 3rd course. We did not find any remarkable side effects except for grade 1 loss of appetite. This chemotherapy was ended after the eighth course. The residual tumor did not disappear but did not grow, and a no change status was maintained for twelve months after the gastrectomy.

Weekly administration of paclitaxel attenuated rectal stenosis caused by multiple peritoneal recurrence 8 years after the resection of gastric carcinoma.

We report a patient with rectal stenosis caused by peritoneal recurrence 8 years after a curative resection of advanced stage gastric carcinoma; the recurrence was effectively treated with the weekly administration of paclitaxel. The patient was a 66-year-old Japanese woman who was admitted to our hospital complaining of abdominal pain and frequent bowel movements. She had undergone total gastrectomy, due to advanced-stage gastric carcinoma with extensive lymph node metastasis, 8 years before, and had taken an oral anticancer agent, fluoropyrimidine, for 4 years after the operation. Colonofiberscopy performed on admission revealed circumferential rectal stenosis located 10 cm from the anal verge. Barium enema study demonstrated extensive poor expansion of the upper and lower rectum and irregularity of the descending colon. Abdominal computed tomography (CT) scanning revealed wall thickening in the rectum and descending colon. These findings were compatible with rectal stenosis caused by the peritoneal recurrence of gastric carcinoma. Weekly administration of paclitaxel was started. The abdominal symptoms soon disappeared when the second cycle of paclitaxel was completed, and they have not appeared since then. The rectal stenosis was attenuated, as confirmed by imaging analyses. Weekly paclitaxel has been effective for more than 13 months, suggesting that the patient is in a state of tumor dormancy of recurrent gastric carcinoma.