Mallory-Weiss tear during gastric endoscopic submucosal dissection

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Oncology

Background:

• Early gastric cancer presents a growing clinical challenge.
• Endoscopic submucosal dissection (ESD) is a minimally invasive treatment option for early gastric neoplasms.
• Accurate diagnosis and management of coexisting gastric lesions are crucial for successful endoscopic treatment.

Purpose of the Study:

• To report a case of early gastric cancer and a coexisting hyperplastic polyp treated with ESD.
• To highlight the unexpected finding and management of a Mallory-Weiss tear during ESD for gastric lesions.
• To evaluate the efficacy and safety of ESD in managing early gastric cancer.

Main Methods:

• Esophagogastroduodenoscopy (EGD) for diagnosis and lesion characterization.
• Endoscopic submucosal dissection (ESD) using carbon dioxide (CO2) insufflation for lesion removal.
• Histopathological examination of resected specimens.
• Hemoclip application for management of intraprocedural bleeding.

Main Results:

• Complete en bloc resection of a T1a papillary adenocarcinoma and a hyperplastic polyp.
• Unexpected identification and successful hemostasis of a Mallory-Weiss tear using eight hemoclips.
• No post-procedural bleeding or perforation.
• Histological confirmation of complete tumor removal without lymphovascular invasion or margin involvement.

Conclusions:

• ESD is a safe and effective treatment for selected early gastric cancers and coexisting lesions.
• Endoscopists must be prepared for unexpected findings, such as Mallory-Weiss tears, during ESD.
• CO2 insufflation may improve patient comfort and safety during ESD procedures.