Clin Endosc.  2021 Nov;54(6):916-919. 10.5946/ce.2020.220.

Perforation of a Gastric Tear during Esophageal Endoscopic Submucosal Dissection under General Anesthesia

• Yamasaki T
• Sakata Y
• Suekane T
• Nebiki H

• KMID: 2522714
• DOI: http://doi.org/10.5946/ce.2020.220

Abstract

Mallory-Weiss tears (MWT) are occasionally encountered during endoscopic procedures. Esophageal endoscopic submucosal dissection (ESD) is widely performed under general anesthesia to avoid unexpected body movements. We present the case of a 68-year-old woman with squamous cell carcinoma. Although ESD was performed under general anesthesia, a gastric perforation at the MWT caused by gastric inflation was observed after the procedure. The perforation was closed endoscopically, and she was discharged without any sequelae. Although general anesthesia is useful for esophageal ESD, it should be noted that it can cause MWT, and in rare cases, gastric perforation, due to gastric inflation during the procedure.

Keyword

Endoscopic submucosal dissection; Gastric perforation; General anesthesia; Mallory-Weiss tear

Figure

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  Fig. 1. (A) Perforation in the tear at the gastric upper body (arrow). (B) Multiple gastric lacerations in the stomach and closure of the perforation site using endoclips.

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  Fig. 2. No perforation or injury to the muscle layer was observed at the ulcer bed after endoscopic submucosal dissection.

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  Fig. 3. Post-procedural computed tomography. (A) Peritoneal gas was observed (arrow). (B) No pneumomediastinum was observed (a nasogastric tube was inserted, arrow).

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  Fig. 4. Microscopic image of resected specimen. There was no evidence of resected muscle layer (hematoxylin and eosin stain ”10).

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