Endoscopic submucosal dissection (ESD) is the standard treatment method for esophageal, gastric, and colorectal cancers. However, it has not been standardized for duodenal lesions because of its high complication rates. Recently, minimally invasive and simple methods such as cold snare polypectomy and underwater endoscopic mucosal resection have been utilized more for superficial nonampullary duodenal epithelial tumors (SNADETs). Although the rate of complications associated with duodenal ESD has been gradually decreasing because of technical advancements, performing ESD for all SNADETs is unnecessary. As such, the appropriate treatment plan for SNADETs should be chosen according to the lesion type, patient condition, and endoscopist’s skill.

A 75-year-old woman visited a hospital complaining of nausea and anorexia. She was diagnosed with stomach malignant lymphoma, and 6 courses of R-CHOP therapy were performed. Since complete remission was obtained, consolidation radiotherapy was decided. When performing radiation therapy on the stomach, it is desirable to carry it out in an empty stomach. For this reason, it is necessary to skip meals before irradiation. However, in this case, scar stenosis remained in gastric vestibular, and there was always a complaint of stomach discomfort. The treatment plan CT was taken without meals, and full stomach was observed. The patient was judged to be unavoidable due to an organic passage disorder, and a treatment plan was made with a full stomach, and radiotherapy was started. However, she was administered hangeshashinto from the first day of radiation therapy, and stomach discomfort quickly improved. CT was performed again, confirming that the stomach volume was reduced. In this case, in addition to scar stenosis in the stomach, it seems that functional dyspepsia was also involved. It is considered that the promoting effect on gastric emptying function of hangeshashinto was confirmed by CT images.