Delayed perforation after endoscopic submucosal dissection treated successfully by temporary stent placement.

Area of Science:

• Gastroenterology
• Gastrointestinal Endoscopy
• Surgical Complications

Background:

• Barrett's esophagus with high-grade dysplasia requires intervention.
• Endoscopic submucosal dissection (ESD) is a minimally invasive endoscopic resection technique.
• Long-segment Barrett's esophagus poses challenges for complete resection.

Observation:

• A patient with extensive Barrett's esophagus underwent successful ESD.
• Delayed esophageal perforation occurred post-ESD, presenting with dyspnea and pneumomediastinum.
• Respiratory failure necessitated ventilatory support.

Findings:

• Successful endoscopic management of delayed esophageal perforation was achieved using two self-expanding metal stents.
• The patient's condition improved, allowing for oral diet resumption and eventual stent removal without stricture formation.
• This represents the first reported case of successful endoscopic therapy for delayed esophageal perforation post-ESD.

Implications:

• Endoscopic stenting is a viable and effective treatment for delayed esophageal perforation following ESD.
• Minimally invasive endoscopic approaches can manage severe complications, avoiding surgical intervention.
• This case highlights the importance of prompt diagnosis and endoscopic management in such scenarios.