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Case Reports
. 2018 Jun 16;10(6):121-124.
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  1 , Masaya Uesato  2 , Takumi Ohta  1 , Kentarou Murakami  1 , Akira Nakano  1 , Hisahiro Matsubara  1
Affiliations
Case Reports

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

Takuma Sasaki et al. World J Gastrointest Endosc. .

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

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Conflict of interest statement

Conflict-of-interest statement: The authors state that they have no conflicts of interest regarding this case report.

Figures

Figure 1
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
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
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.
See this image and copyright information in PMC

References

    1. Miyazaki S, Gunji Y, Aoki T, Nakajima K, Nabeya Y, Hayashi H, Shimada H, Uesato M, Hirayama N, Karube T, et al. High en bloc resection rate achieved by endoscopic mucosal resection with IT knife for early gastric cancer. Hepatogastroenterology. 2005;52:954–958. - PubMed
    1. Uesato M, Nabeya Y, Akai T, Inoue M, Watanabe Y, Kawahira H, Mamiya T, Ohta Y, Motojima R, Kagaya A, et al. Salivary amylase activity is useful for assessing perioperative stress in response to pain in patients undergoing endoscopic submucosal dissection of gastric tumors under deep sedation. Gastric Cancer. 2010;13:84–89. - PubMed
    1. Asano M, Nan Y, Ando H. A case of early gastric cancer at the cardia treated endoscopically under endoscopic gastrostomy. Gastrointest Endosc. 1993;35:2687–2692.
    1. Tokumo H, Komatsu H, Ishida K, Morinaka K, Ito M. Transgastrostomal endoscopic mucosal resection for the treatment of gastric mucosal lesions. Gastrointest Endosc. 1997;39:1775–1780.
    1. Nishiwaki S, Araki H, Niwa Y, Kubota M, Shirakami Y, Gotoh N, Iwashita M, Onogi N, Hayashi T, Maeda T, et al. Usefulness of transgastrostomic endoscopy (TEG) in patient with post percutaneous endoscopic gastrostomy (PEG) Gastrointest Endosc. 2005;47:49–55.

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