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Utility of the over-the-scope-clip system for treating a large esophageal perforation.

Ono H, Tanaka M, Takizawa K, Kakushima N, Kawata N, Imai K, Hotta K, Matsubayashi H - Esophagus (2014)

Bottom Line: Perforation closure with a conventional endoclip was difficult as the perforation was large and the surrounding tissue was fragile as a result of steroids administration for stenosis prevention.To avoid surgical intervention, we employed the over-the-scope-clip system and successfully closed the perforation.The favorable outcome suggests the utility of the over-the-scope-clip system for closing perforations when conventional methods are ineffective.

View Article: PubMed Central - PubMed

Affiliation: Division of Endoscopy, Shizuoka Cancer Center, Shimonagakubo 1007, Nagaizumi-cho, Sunto-Gun, Shizuoka 411-8777 Japan.

ABSTRACT

We report here a case of esophageal perforation made by an endoscope while treating cicatrical stenosis that developed after wide circumferential dissection of superficial esophageal carcinoma. Perforation closure with a conventional endoclip was difficult as the perforation was large and the surrounding tissue was fragile as a result of steroids administration for stenosis prevention. To avoid surgical intervention, we employed the over-the-scope-clip system and successfully closed the perforation. The favorable outcome suggests the utility of the over-the-scope-clip system for closing perforations when conventional methods are ineffective.

No MeSH data available.


Related in: MedlinePlus

Endoscopic submucosal dissection (ESD) and an ulcer showing stenosis and perforation. a Superficial esophageal carcinoma about three-fourths the circumference of the esophagus located in the upper thoracic esophagus. b Immediately after esophageal endoscopic submucosal dissection (ESD), circumferential dissection was performed. c Cicatrical stenosis 3 months after esophageal ESD. d Large perforation due to the endoscope penetrating the wall in the upper-right side of the stenotic area
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Fig1: Endoscopic submucosal dissection (ESD) and an ulcer showing stenosis and perforation. a Superficial esophageal carcinoma about three-fourths the circumference of the esophagus located in the upper thoracic esophagus. b Immediately after esophageal endoscopic submucosal dissection (ESD), circumferential dissection was performed. c Cicatrical stenosis 3 months after esophageal ESD. d Large perforation due to the endoscope penetrating the wall in the upper-right side of the stenotic area

Mentions: A 64-year-old woman presented with subcircumferential superficial esophageal carcinoma three-fourths the circumference of the esophagus in the upper thoracic esophagus (Fig. 1a). The depth of tumor invasion was evaluated as cT1a-MM by white light observation, narrow band imaging with magnifying endoscopy, and endoscopic ultrasound. No lymph node metastasis was evident on computed tomography (CT) images. Preoperative diagnosis was 0-IIc, cT1a-MM, 40 mm, cN0, cStage 0. According to the Japanese guidelines for the diagnosis and treatment of esophageal cancer, the Cancer Board for esophageal cancer of our hospital decided to perform ESD [3]. After obtaining informed consent, ESD was performed using an IT knife nano (KD-612, Olympus Medical Systems, Tokyo, Japan). Circumferential dissection (Fig. 1b) was necessary and to prevent the likely onset of stenosis, she received a local injection of triamcinolone acetonide (100 mg) into the submucosa underlying the ulcer immediately after ESD and was started on oral predonine therapy (30 mg/day) 1 week after ESD, which was tapered over a 2-month period. Histopathology findings indicated squamous cell carcinoma (0-IIc type, T1a-MM, ly1, v0, HM(−), and VM(−)). Additional treatment was considered because of the high risk for lymph node metastasis suggested by a positive finding of lymphatic involvement.Fig. 1


Utility of the over-the-scope-clip system for treating a large esophageal perforation.

Ono H, Tanaka M, Takizawa K, Kakushima N, Kawata N, Imai K, Hotta K, Matsubayashi H - Esophagus (2014)

Endoscopic submucosal dissection (ESD) and an ulcer showing stenosis and perforation. a Superficial esophageal carcinoma about three-fourths the circumference of the esophagus located in the upper thoracic esophagus. b Immediately after esophageal endoscopic submucosal dissection (ESD), circumferential dissection was performed. c Cicatrical stenosis 3 months after esophageal ESD. d Large perforation due to the endoscope penetrating the wall in the upper-right side of the stenotic area
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4490167&req=5

Fig1: Endoscopic submucosal dissection (ESD) and an ulcer showing stenosis and perforation. a Superficial esophageal carcinoma about three-fourths the circumference of the esophagus located in the upper thoracic esophagus. b Immediately after esophageal endoscopic submucosal dissection (ESD), circumferential dissection was performed. c Cicatrical stenosis 3 months after esophageal ESD. d Large perforation due to the endoscope penetrating the wall in the upper-right side of the stenotic area
Mentions: A 64-year-old woman presented with subcircumferential superficial esophageal carcinoma three-fourths the circumference of the esophagus in the upper thoracic esophagus (Fig. 1a). The depth of tumor invasion was evaluated as cT1a-MM by white light observation, narrow band imaging with magnifying endoscopy, and endoscopic ultrasound. No lymph node metastasis was evident on computed tomography (CT) images. Preoperative diagnosis was 0-IIc, cT1a-MM, 40 mm, cN0, cStage 0. According to the Japanese guidelines for the diagnosis and treatment of esophageal cancer, the Cancer Board for esophageal cancer of our hospital decided to perform ESD [3]. After obtaining informed consent, ESD was performed using an IT knife nano (KD-612, Olympus Medical Systems, Tokyo, Japan). Circumferential dissection (Fig. 1b) was necessary and to prevent the likely onset of stenosis, she received a local injection of triamcinolone acetonide (100 mg) into the submucosa underlying the ulcer immediately after ESD and was started on oral predonine therapy (30 mg/day) 1 week after ESD, which was tapered over a 2-month period. Histopathology findings indicated squamous cell carcinoma (0-IIc type, T1a-MM, ly1, v0, HM(−), and VM(−)). Additional treatment was considered because of the high risk for lymph node metastasis suggested by a positive finding of lymphatic involvement.Fig. 1

Bottom Line: Perforation closure with a conventional endoclip was difficult as the perforation was large and the surrounding tissue was fragile as a result of steroids administration for stenosis prevention.To avoid surgical intervention, we employed the over-the-scope-clip system and successfully closed the perforation.The favorable outcome suggests the utility of the over-the-scope-clip system for closing perforations when conventional methods are ineffective.

View Article: PubMed Central - PubMed

Affiliation: Division of Endoscopy, Shizuoka Cancer Center, Shimonagakubo 1007, Nagaizumi-cho, Sunto-Gun, Shizuoka 411-8777 Japan.

ABSTRACT

We report here a case of esophageal perforation made by an endoscope while treating cicatrical stenosis that developed after wide circumferential dissection of superficial esophageal carcinoma. Perforation closure with a conventional endoclip was difficult as the perforation was large and the surrounding tissue was fragile as a result of steroids administration for stenosis prevention. To avoid surgical intervention, we employed the over-the-scope-clip system and successfully closed the perforation. The favorable outcome suggests the utility of the over-the-scope-clip system for closing perforations when conventional methods are ineffective.

No MeSH data available.


Related in: MedlinePlus