Gastric endoscopic submucosal dissection via gastrostoma before the second operation for esophageal perforation: A case report

Figure 1 Schematic illustration of esophagectomy. A: This schematic illustration shows the middle thoracic esophageal cancer (1T4b), two gastric cancers (2T1b,3T1a), esophageal perforation (4) and the cutting line of the emergent operation (dotted line); B: After the emergent operation, one gastric cancer (3) remained at the middle posterior wall with the gastrostoma at the anterior wall (arrow).

Figure 2 Results of gastric endoscopic submucosal dissection. A: The remnant gastric lesion located at the middle posterior wall showed a mucosal cancer lesion about 10 mm in diameter; B: Just after the insertion of the scope into the stomach, Funada-type gastric wall fixation (arrow) (Create Medic, Tokyo, Japan) was performed at two opposite sites; C: A hemoclip (Olympus, Tokyo, Japan) with thread (arrow) was attached to the specimen, and the thread was pulled via the gastrostoma.

Figure 3 Gross appearance of the resected gastric mucosa is shown. A superficial depressed tumor measuring 14 mm × 10 mm (white dot) was observed macroscopically.