Utility of the over-the-scope-clip system for treating a large esophageal perforation

Abstract

We report here a case of esophageal perforation made by an endoscope while treating cicatrical stenosis that developed after wide circumferential dissection of superficial esophageal carcinoma. Perforation closure with a conventional endoclip was difficult as the perforation was large and the surrounding tissue was fragile as a result of steroids administration for stenosis prevention. To avoid surgical intervention, we employed the over-the-scope-clip system and successfully closed the perforation. The favorable outcome suggests the utility of the over-the-scope-clip system for closing perforations when conventional methods are ineffective.

Keywords: Clips; Endoscopic surgical procedure; Esophageal perforation; Esophagus.

Fig. 1

Endoscopic submucosal dissection (ESD) and an ulcer showing stenosis and perforation. a Superficial esophageal carcinoma about three-fourths the circumference of the esophagus located in the upper thoracic esophagus. b Immediately after esophageal endoscopic submucosal dissection (ESD), circumferential dissection was performed. c Cicatrical stenosis 3 months after esophageal ESD. d Large perforation due to the endoscope penetrating the wall in the upper-right side of the stenotic area

Fig. 2

Suturing devices and perforation closure. a The over-the-scope-clip (OTSC) system showing the OTSC Twin Grasper with its branches open outside the endoscope and two clips (image reproduced with the permission of Century Medical Inc., Tokyo, Japan). b The perforation was closed by clipping the muscular layer with the OTSC system

Fig. 3

Non-contrast radiography showing the OTSC system in use (left) and contrast radiography showing no leakage (right)

Fig. 4

Endoscopic image taken 2 months after completing chemotherapy. The endoscope could traverse the site despite the presence of minor stenosis