Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jun 16, 2018; 10(6): 121-124
Published online Jun 16, 2018. doi: 10.4253/wjge.v10.i6.121
Gastric endoscopic submucosal dissection via gastrostoma before the second operation for esophageal perforation: A case report
Takuma Sasaki, Masaya Uesato, Takumi Ohta, Kentarou Murakami, Akira Nakano, Hisahiro Matsubara
Takuma Sasaki, Masaya Uesato, Takumi Ohta, Kentarou Murakami, Akira Nakano, Hisahiro Matsubara, Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba 260-8677, Japan
Author contributions: Sasaki T and Uesato M wrote the manuscript; Sasaki T, Uesato M, Ohta T, Murakami K and Nakano A diagnosed and treated the patient; all authors discussed the results and commented on the manuscript.
Informed consent statement: The patient involved in this study gave his written informed consent authorizing the use and disclosure of his protected health information.
Conflict-of-interest statement: The authors state that they have no conflicts of interest regarding this case report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Masaya Uesato, MD, PhD, Assistant Professor, Doctor, Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan. uesato@faculty.chiba-u.jp
Telephone: +81-43-2262110 Fax: +81-43-2262113
Received: February 2, 2018
Peer-review started: February 2, 2018
First decision: February 28, 2018
Revised: March 2, 2018
Accepted: March 20, 2018
Article in press: March 20, 2018
Published online: June 16, 2018
Processing time: 133 Days and 2.2 Hours
Abstract

A 69-year-old man with advanced esophageal cancer and 2 early gastric cancers received chemoradiotherapy and was scheduled to undergo subtotal esophagectomy after gastric endoscopic submucosal dissection (ESD). However, left lower esophageal perforation induced by vomiting suddenly occurred, and he urgently underwent esophago-proximal gastrectomy and gastrostomy without reconstruction. The resected specimen showed a complete response of pretreatment for the esophageal cancer and radical resection of one gastric cancer. Radical resection of the other gastric lesion was necessary before reconstruction. The fistula of gastrostoma was gradually dilated from 6.7 to 9.3 mm in order to pass the endoscope. At nine months after emergent operation, gastric ESD was performed via only the gastrostoma. A hemoclip with thread was attached to the specimen, and the thread was pulled out of the gastrostoma. The specimen was able to be removed en bloc, resulting in radical resection. Gastric tube reconstruction through the posterior sternal route was performed at six months after the ESD. He has not developed recurrence of the esophageal or gastric cancer in the two years since the emergent operation.

Keywords: Gastric cancer; Endoscopic submucosal dissection; Gastrostomy; Gastrostoma

Core tip: Gastric endoscopic submucosal dissection (ESD), which is a useful and minimally invasive procedure for early gastric cancer, is usually performed through the mouth. This patient’s stomach had a gastrostoma that was not connected to the mouth after surgery for esophageal perforation. The fistula of the gastrostoma was dilated in order to pass the endoscope. ESD for the early gastric cancer was performed via the gastrostoma. The specimen was able to be removed en bloc, and the residual stomach was able to be used for reconstruction. We herein report a unique gastric ESD technique using a gastrostoma.