Delayed perforation after endoscopic submucosal dissection treated successfully by temporary stent placement
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A 71-year-old male patient with a long-segment (C10M12) Barrett’s esophagus harboring multifocal high-grade dysplasia was referred to our clinic. After a multidisciplinary team conference and the patient’s informed consent, an endoscopic submucosal dissection (ESD) was performed with resection of 4/5 of the esophageal circumference along 12 cm, without any complications during or immediately after the procedure. In the day after the ESD, the patient presented suddenly with dyspnea and subcutaneous emphysema in the neck and chest. A computed tomography (CT) showed subcutaneous emphysema in the neck and pneumomediastinum, confirming the diagnosis of delayed perforation. There was gradual progression into respiratory failure with the need for ventilatory support. Endoscopic treatment was decided and 2 fully covered self-expandable metal stents were deployed in the esophagus. Patient’s clinical condition improved and oral diet was resumed at day 7. Stents were retrieved at day 12 and there were no strictures on the 2 and 6-month follow-ups. This is the first report of delayed perforation after endoscopic submucosal disection in the esophagus that was successfully managed with endoscopic therapy.
KeywordsBarrett’s esophagus High-grade dysplasia Endoscopic submucosal dissection Delayed perforation Temporary stent placement
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
Informed consent was obtained from all patients for being included in the study.
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