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Published on: April 17, 2020
Successful perforation management during esophageal endoscopic submucosal dissection using the stent-anchoring
Mai Utsumi1,2, Taro Iwatsubo2, Kazuki Takayama2
1Gastroenterology Center Hirakata Municipal Hospital Osaka Japan.
Abstract:
Patients with esophageal endoscopic submucosal dissection-associated adverse events can have a severe clinical course. In this report, we describe the case of a 67-year-old male with a history of endoscopic submucosal dissection who had metachronous superficial esophageal cancer. Although endoscopic submucosal dissection was attempted for challenging lesions adjacent to the scar, perforations occurred during the procedure. We placed an esophageal fully covered self-expandable metallic stent at the perforation site to avoid emergency surgery after lesion removal. However, stent migration and displacement concerns remained, as no stenosis was observed in the esophagus. Therefore, a clip with a thread on the upper edge of the stent was placed, and this anchoring clip was useful in preventing stent migration and closing the perforation. The patient improved with conservative treatment. In conclusion, the stent placement and anchoring method with clip and thread could be a treatment option in such cases.
Insights
A novel technique using a stent anchored with a clip and thread successfully treated esophageal perforation during endoscopic submucosal dissection. This method prevented stent migration and perforation closure, offering a conservative treatment option for adverse events.
Area of Science:
- Gastroenterology
- Endoscopy
- Surgical Innovation
Background:
- Esophageal endoscopic submucosal dissection (ESD) can lead to severe adverse events, including perforation.
- Managing perforations post-ESD often requires complex interventions or emergency surgery.
Purpose of the Study:
- To describe a novel method for managing esophageal perforation following ESD.
- To evaluate the efficacy of a fully covered self-expandable metallic stent (FCSEMS) anchored with a clip and thread.
Main Methods:
- A 67-year-old male with metachronous superficial esophageal cancer underwent ESD.
- Perforation occurred during ESD for a challenging lesion; an FCSEMS was placed.
- An anchoring clip with a thread was used to prevent stent migration and aid perforation closure.
Main Results:
- The anchoring clip successfully prevented stent migration.
- The method facilitated perforation closure and allowed for conservative management.
- The patient demonstrated clinical improvement without requiring emergency surgery.
Conclusions:
- Stent placement combined with an anchoring clip and thread is a viable treatment option for esophageal perforations post-ESD.
- This technique offers a less invasive alternative to emergency surgery for managing ESD-associated perforations.
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