Case Report
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Aug 21, 2012; 18(31): 4224-4227
Published online Aug 21, 2012. doi: 10.3748/wjg.v18.i31.4224
Dehiscence following successful endoscopic closure of gastric perforation during endoscopic submucosal dissection
Masau Sekiguchi, Haruhisa Suzuki, Ichiro Oda, Shigetaka Yoshinaga, Satoru Nonaka, Makoto Saka, Hitoshi Katai, Hirokazu Taniguchi, Ryoji Kushima, Yutaka Saito
Masau Sekiguchi, Haruhisa Suzuki, Ichiro Oda, Shigetaka Yoshinaga, Satoru Nonaka, Yutaka Saito, Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
Makoto Saka, Hitoshi Katai, Gastric Surgery Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
Hirokazu Taniguchi, Ryoji Kushima, Pathology Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
Author contributions: Sekiguchi M, Suzuki H, and Oda I designed the study, analyzed and interpreted the data, and drafted the article; Yoshinaga S, Nonaka S, Saka M, Katai H, Taniguchi H, Kushima R, and Saito Y contributed to the discussion and reviewed the manuscript; all the authors had final approval of the article.
Correspondence to: Haruhisa Suzuki, MD, Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. harusuzu@ncc.go.jp
Telephone: +81-3-35422511 Fax: +81-3-35423815
Received: March 1, 2012
Revised: April 17, 2012
Accepted: April 20, 2012
Published online: August 21, 2012
Abstract

Gastric perforation is one of the most serious complications that can occur during endoscopic submucosal dissection (ESD). In terms of the treatment of such perforations, we previously reported that perforations immediately observed and successfully closed with endoclips during endoscopic resection could be managed conservatively. We now report the first case in our medical facility of a gastric perforation during ESD that was ineffectively treated conservatively even after successful endoscopic closure. In December 2006, we performed ESD on a recurrent early gastric cancer in an 81-year-old man with a medical history of laparotomy for cholelithiasis. A perforation occurred during ESD that was immediately observed and successfully closed with endoclips so that ESD could be continued resulting in an en-bloc resection. Intensive conservative management was conducted following ESD, however, an endoscopic examination five days after ESD revealed dehiscence of the perforation requiring an emergency laparotomy.

Keywords: Early gastric cancer; Endoscopic closure; Endoscopic submucosal dissection; Gastric perforation; Laparotomy