Endoscopic tissue shielding for esophageal perforation caused by endoscopic resection

Abstract

In Japan, endoscopic resection (ER), including endoscopic mucosal resection and endoscopic submucosal dissection, is widely performed for superficial esophageal neoplasms and accepted as a minimally invasive treatment. Perforation is a major complication of ER, with an incidence rate of 1-5%. While conservative treatment has become a more common choice, surgical treatment of perforations is sometimes required, especially for large perforations. Of 1408 cases of esophageal ER that have been performed, 17 cases of perforation occurred at the Cancer Institute Hospital between 2005 and 2016. Most cases were treated with endoscopic clipping and managed conservatively; however, 2 cases were not eligible for endoscopic closure. We report two cases of large perforations of 15 and 20 mm, respectively. Both cases were treated conservatively with endoscopic tissue shielding, in which the perforations were covered with a large polyglycolic acid (PGA) sheet that was affixed with fibrin glue. Neither of the cases required open surgery. In both cases, feeding started three weeks after the procedure (19 and 21 days), and both were discharged within a month (29 and 30 days). In conclusion, tissue shielding with PGA sheets in large perforations after esophageal ER is a good choice to safely proceed with conservative treatment. On the other hand, endoscopic clipping is effective and reasonable for small perforations.

Keywords: Endoscopic resection; Endoscopic tissue shielding; Esophageal perforation; Polyglycolic acid (PGA) sheet; Superficial esophageal neoplasm.