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Endoscopic tissue shielding for esophageal perforation caused by endoscopic resection
Ryo Takahashi1, Toshiyuki Yoshio2, Yusuke Horiuchi1
1Department of Gastroenterology Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Clinical Journal of Gastroenterology
|April 2, 2017
Summary
Endoscopic resection (ER) for esophageal neoplasms can cause perforations. Tissue shielding with polyglycolic acid (PGA) sheets offers a safe, conservative treatment for large perforations, avoiding surgery.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
- Medical Device Technology
Background:
- Endoscopic resection (ER) is a standard minimally invasive treatment for superficial esophageal neoplasms in Japan.
- Perforation is a significant complication of ER, occurring in 1-5% of cases.
- While conservative management is common, large perforations may necessitate surgical intervention.
Observation:
- Two cases of large esophageal perforations (15-20 mm) following ER were reported.
- These large perforations were not amenable to standard endoscopic clipping.
- Both patients were successfully treated conservatively using endoscopic tissue shielding with polyglycolic acid (PGA) sheets and fibrin glue.
Findings:
- Endoscopic tissue shielding with PGA sheets effectively managed large esophageal perforations.
- Neither patient required open surgery.
- Patients experienced successful feeding initiation and discharge within one month.
Implications:
- Tissue shielding with PGA sheets is a viable and safe conservative treatment option for large perforations after esophageal ER.
- Endoscopic clipping remains effective for smaller perforations.
- This technique may reduce the need for surgical intervention in complex ER complications.