Sasaki T, Uesato M, Ohta T, Murakami K, Nakano A, Matsubara H. Gastric endoscopic submucosal dissection via gastrostoma before the second operation for esophageal perforation: A case report. World J Gastrointest Endosc 2018; 10(6): 121-124 [PMID: 29988852 DOI: 10.4253/wjge.v10.i6.121]
Corresponding Author of This Article
Masaya Uesato, MD, PhD, Assistant Professor, Doctor, Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan. uesato@faculty.chiba-u.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Takuma Sasaki, Masaya Uesato, Takumi Ohta, Kentarou Murakami, Akira Nakano, Hisahiro Matsubara, Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba 260-8677, Japan
Author contributions: Sasaki T and Uesato M wrote the manuscript; Sasaki T, Uesato M, Ohta T, Murakami K and Nakano A diagnosed and treated the patient; all authors discussed the results and commented on the manuscript.
Informed consent statement: The patient involved in this study gave his written informed consent authorizing the use and disclosure of his protected health information.
Conflict-of-interest statement: The authors state that they have no conflicts of interest regarding this case report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Masaya Uesato, MD, PhD, Assistant Professor, Doctor, Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan. uesato@faculty.chiba-u.jp
Telephone: +81-43-2262110 Fax: +81-43-2262113
Received: February 2, 2018 Peer-review started: February 2, 2018 First decision: February 28, 2018 Revised: March 2, 2018 Accepted: March 20, 2018 Article in press: March 20, 2018 Published online: June 16, 2018 Processing time: 133 Days and 2.2 Hours
ARTICLE HIGHLIGHTS
Case characteristics
A 69-year-old man with advanced esophageal cancer and 2 early gastric cancers received chemoradiotherapy and he was scheduled to undergo subtotal esophagectomy after gastric endoscopic submucosal dissection. However, left lower esophageal perforation suddenly occurred, and he urgently underwent esophago-proximal gastrectomy and gastrostomy.
Clinical diagnosis
The patient had one early cancer in the residual stomach without a connection to the esophagus.
Imaging diagnosis
The only viable approach to the residual stomach was the gastrostoma.
Treatment
The fistula of the gastrostoma was gradually dilated to allow the endoscope to pass through. Gastric endoscopic submucosal dissection was performed via only the gastrostoma. A hemoclip with thread was attached to the specimen, and the thread was pulled via the gastrostoma. The specimen was able to be removed en bloc. Gastric tube reconstruction was performed.
Experiences and lessons
We successfully performed gastric endoscopic submucosal dissection through only the fistula of a gastrostoma. To ensure safety and success, the gradual tube dilation of fistula, traction with a hemoclip and thread through the gastrostoma and frequent hemostasis should be considered.
