A 74-year-old female, who was diagnosed with superficial esophageal cancer, underwent endoscopic submucosal dissection (ESD) at another hospital, but a perforation occurred during the procedure. The perforation was closed with endoscopic clips, and the ESD was halted. The patient was referred to our hospital, and ESD was retried. There was severe fibrosis around the lesion, and injections into the submucosal layer were difficult. In addition, it was not possible to identify the submucosal layer, and making an oral-side incision caused a large perforation along the incision line. As continuing the submucosal dissection with an endoknife was considered difficult, the lesion was finally resected with hybrid ESD using a snare. The perforation was closed using polyglycolic acid (PGA) sheets and fibrin glue. Endoscopy performed 6 days later showed that the defect had been closed, and no contrast leakage was detected. Follow-up endoscopy conducted 3 months after the ESD showed ulcer healing at the dissection site and scar formation, but no residual tumor or esophageal stricture was noted. Our experience suggests that the use of PGA sheets with fibrin glue is a feasible, safe, and effective way of treating large esophageal perforations during ESD.
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None of the authors have any conflicts of interest that are relevant to the content of this article.
Inoue H, Minami H, Kaga M, et al. Endoscopic mucosal resection and endoscopic submucosal dissection for esophageal dysplasia and carcinoma. Gastrointest Endosc Clin N Am. 2010;20:25–34, v–vi.CrossRefGoogle Scholar
Tsujii Y, Nishida T, Nishiyama O, et al. Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms: a multicenter retrospective cohort study. Endoscopy. 2015;47:775–83.CrossRefGoogle Scholar
Isomoto H, Yamaguchi N, Minami H, et al. Management of complications associated with endoscopic submucosal dissection/endoscopic mucosal resection for esophageal cancer. Dig Endosc. 2013;25(Suppl 1):29–38.CrossRefGoogle Scholar
Kim JS, Kim BW, Shin IS. Efficacy and safety of endoscopic submucosal dissection for superficial squamous esophageal neoplasia: a meta-analysis. Dig Dis Sci. 2014;59:1862–9.CrossRefGoogle Scholar
Bailey SH, Bull DA, Harpole DH, et al. Outcomes after esophagectomy: a ten-year prospective cohort. Ann Thorac Surg. 2003;75:217–22.CrossRefGoogle Scholar
Akimoto T, Goto O, Nishizawa T, et al. Endoscopic closure after intraluminal surgery. Dig Endosc. 2017;29:547–58.CrossRefGoogle Scholar
Hagel AF, Naegel A, Lindner AS, et al. Over-the-scope clip application yields a high rate of closure in gastrointestinal perforations and may reduce emergency surgery. J Gastrointest Surg. 2012;16:2132–8.CrossRefGoogle Scholar
Takimoto K, Imai Y, Matsuyama K. Endoscopic tissue shielding method with polyglycolic acid sheets and fibrin glue to prevent delayed perforation after duodenal endoscopic submucosal dissection. Dig Endosc. 2014;26(Suppl 2):46–9.CrossRefGoogle Scholar
Sakaguchi Y, Tsuji Y, Yamamichi N, et al. Successful closure of a large perforation during colorectal endoscopic submucosal dissection by application of polyglycolic acid sheets and fibrin glue. Gastrointest Endosc. 2016;84:374–5.CrossRefGoogle Scholar
Zhong H, Ma L, Zhang Y, et al. Nonsurgical treatment of 8 cases with esophageal perforations caused by ESD. Int J Clin Exp Med. 2015;8:21760–4.Google Scholar
Ono H, Tanaka M, Takizawa K, et al. Utility of the over-the-scope-clip system for treating a large esophageal perforation. Esophagus. 2015;12:336–9.CrossRefGoogle Scholar
von Renteln D, Denzer UW, Schachschal G, et al. Endoscopic closure of GI fistulae by using an over-the-scope clip (with videos). Gastrointest Endosc. 2010;72:1289–96.CrossRefGoogle Scholar
Tanaka S, Toyonaga T, Ohara Y, et al. Esophageal diverticulum exposed during endoscopic submucosal dissection of superficial cancer. World J Gastroenterol. 2015;21:3121–6.CrossRefGoogle Scholar
Ohara Y, Takimoto K, Toyonaga T, et al. Enormous postoperative perforation after endoscopic submucosal dissection for duodenal cancer successfully treated with filling and shielding by polyglycolic acid sheets with fibrin glue and computed tomography-guided abscess puncture. Clin J Gastroenterol. 2017;10:524–9.CrossRefGoogle Scholar
Hayashibe A, Sakamoto K, Shinbo M, et al. New method for prevention of bile leakage after hepatic resection. J Surg Oncol. 2006;94:57–60.CrossRefGoogle Scholar
Uemura K, Murakami Y, Hayashidani Y, et al. Combination of polyglycolic acid felt and fibrin glue for prevention of pancreatic fistula following pancreaticoduodenectomy. Hepatogastroenterology. 2009;56:1538–41.Google Scholar
Iizuka T, Kikuchi D, Hoteya S, et al. Polyglycolic acid sheet and fibrin glue for preventing esophageal stricture after endoscopic submucosal dissection: a historical control study. Dis Esophagus. 2017;30:1–8.CrossRefGoogle Scholar