A 62-yr-old Japanese man with end stage renal failure showed persistant anemia in the last 6 months. He had undergone Billroth-II partial gastrectomy for gastric ulcer 36 years ago. Endoscopic examination revealed polypoid lesions with an erosion around the gastrojejunostomy site, and biopsy from the erosion showed poorly differentiated adenocarcinoma. Because the patient refused operation, laser irradiation was performed under the diagnosis of gastric carcinoma in SPHG. Unfortunately, massive bleeding occurred thereafter and an emergency operation was done. Histologically, the resected specimen showed double early gastric carcinomas (III+IIc and IIc) which were situated on the SPHG. In the III+IIc type early gastric carcinoma, residual carcinoma around the laser-induced shallow ulcer and exposed distorted arteriole at the floor of the ulcer were found. We stressed the possibility of massive bleeding on endoscopic therapy of the carcinoma developed in the SPHG.
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