Long-term endoscopic submucosal dissection with postoperative lung injury: a case report

Area of Science:

• Gastroenterology
• Surgical Oncology
• Critical Care Medicine

Background:

• Endoscopic submucosal dissection (ESD) is a standard minimally invasive treatment for early gastric cancer.
• This case details an extended-duration ESD for a large gastric tumor.
• The procedure was complicated by intraoperative perforation and significant bleeding.

Observation:

• A 72-year-old woman underwent a 9-hour ESD for a 3.1 × 3.5 cm gastric tumor.
• The tumor's adherence to deeper layers and the greater omentum necessitated extensive hemostasis and suturing.
• Intra-abdominal hypertension (IAH) was managed with abdominal puncture due to carbon dioxide insufflation.

Findings:

• The patient developed acute lung injury (ALI) post-operatively, requiring intensive care unit (ICU) admission.
• Prolonged operative time and IAH secondary to perforation were identified as critical factors.
• These complications are associated with a poorer prognosis in patients undergoing ESD.

Implications:

• Extended operative times in ESD procedures can negatively impact patient outcomes.
• Awareness of the risks associated with intra-abdominal hypertension during ESD is crucial.
• Protecting vital organ function during complex gastrointestinal endoscopic procedures requires vigilant management.