Dehiscence following successful endoscopic closure of gastric perforation during endoscopic submucosal dissection

Figure 1 Endoscopic submucosal dissection of a recurrent tumor in December 2006. A: Pre-treatment endoscopy. A recurrent tumor 20 mm in size was detected at the site of the initial endoscopic submucosal dissection (ESD) scar by surveillance endoscopy; B: Endoscopic treatment. ESD was performed on the recurrent tumor, and an oval perforation 5 mm in length occurred at the site of extensive fibrosis during ESD; C: Endoscopic closure of the gastric perforation. The perforation was immediately observed and successfully closed with endoclips so that ESD could be continued resulting in en-bloc resection; D: Microscopic examination. A well to moderately differentiated mucosal adenocarcinoma without lymphovascular involvement was shown (hematoxylin and eosin stain, × 40); E, F: Histopathologically, an ulcer scar from the initial ESD (Ul-IIIs) was also shown [between arrowheads (E)] [hematoxylin and eosin stain, × 1 (E), × 20 (F)].

Figure 2 Dehiscence following successful endoscopic closure of the gastric perforation. A: Endoscopy five days after endoscopic submucosal dissection (ESD). The split-open perforation previously closed successfully with endoclips during ESD was revealed; B: Surgical findings. A perforation of the gastric wall extending to the omental bursa 30 mm × 10 mm in length was seen. The perforation site was not covered with adipose tissue.