Esophageal diverticulum exposed during endoscopic submucosal dissection of superficial cancer

Abstract

Endoscopic submucosal dissection (ESD) is now widely accepted as a strategy to treat superficial esophageal neoplasms. The rate of adverse events, such as perforation, has been decreasing with the improvement of devices and techniques. In this paper, we report a case of esophageal cancer that had a diverticulum under cancerous epithelium. The diverticulum was not detected during preoperative examination, and led to perforation during the ESD procedure. Our case shows that, although rare, some diverticula can exist underneath the mucosal surface without obvious depression. If there is any sign of hidden diverticula during ESD, surgeons should proceed with caution or, depending on the case, the procedure should be discontinued to avoid adverse events.

Keywords: Endoscopic submucosal dissection; Esophageal cancer; Diverticula; Perforation

Core tip: We report a case of esophageal cancer with a diverticulum in a patient who underwent endoscopic submucosal dissection (ESD). Although most esophageal diverticula can be diagnosed by endoscopy or computed tomography scans, the diverticulum in this case was not detected by these examinations before ESD, and led to perforation during the ESD procedure. This is a rare case; however, we should be aware that there could be diverticula without obvious depression.