The upper loculus is spherical in shape while the lower loculus is a narrow and tubular structure. It is also known as “cup and spill stomach” or “champagne cup deformity”. Clinically, it can present with nonspecific upper abdominal symptoms.
In large series of 627 patients by Kusano M, et al. cascade stomach is significantly associated with upper GI symptoms, especially reflux symptoms, indicating that cascade stomach should be considered as pathophysiological factor causing upper GI symptoms.
In our case, patient had significant reflux symptoms with Grade D esophagitis on UGI endoscopy. Endoscopy showed a ridge extending from lesser curvature toward greater curvature dividing stomach into two loculations with acute angulation between two. This can impose technical challenge, to negotiate further endoscopist should push the shaft hard while twisting it a sharp angle with the right hand, after flattening an acute curve from fundus to body of the stomach by relieving the inflation with air suction.
Treatment:
PPI with prokinetics, Breathing exercises if failed surgery either sleeve resection or Nissen fundoplication.
Reference:
1. Kusano, M., Hosaka, H., Moki, H., Shimoyama, Y., Kawamura, O., Kuribayashi, S., Mori, M. and Akuzawa, M. (2012), Cascade stomach is associated with upper gastrointestinal symptoms: a population-based study. Neurogastroenterology & Motility, 24: 451–455.
2. Seung-Hwa Lee, et al. Technical skills and trainig in upper GI endoscopy. WJG 2015