Tang Shou-jiang, Tang Linda, Jazrawi Saad F, Meyer Dan, Wait Michael A, Myers Larry L
Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas 75390-9151, USA.
Laryngoscope. 2009 Jan;119(1):36-8. doi: 10.1002/lary.20006.
Diagnostic esophagogastroduodenoscopy (EGD) is generally a very safe procedure. We report the first case of iatrogenic esophageal submucosal dissection after an attempted diagnostic gastroscopy in a patient with a small previously undiagnosed Zenker's diverticulum (ZD). After EGD, she developed severe dysphagia with the inability to swallow solids, liquids, and even her own saliva. On barium swallow study, there was a column of contrast below the upper esophageal sphincter, and this was misdiagnosed as a large ZD by the radiologist. The resultant stricture was successfully managed with endoscopic balloon dilatation under fluoroscopy with wire-guided cannulation. The ZD was treated with flexible endoscopic clip-assisted diverticulotomy. Iatrogenic submucosal dissection is a unique complication of upper endoscopy. Endoscopists, otolaryngologists, radiologists, and cardiothoracic surgeons should be aware of this condition and prepare to manage it appropriately. If the patient is stable and the possibility of perforation is small, conservative and supportive care can be tried first. A surgical gastrostomy tube can be placed for enteral feeding. In patients with ZD, ZD recognition and gentle manipulation is strongly recommended during esophageal intubation.
诊断性食管胃十二指肠镜检查（EGD）通常是一种非常安全的操作。我们报告了首例在一名先前未被诊断出患有小的Zenker憩室（ZD）的患者进行诊断性胃镜检查尝试后发生医源性食管黏膜下剥离的病例。EGD检查后，她出现了严重的吞咽困难，无法吞咽固体、液体，甚至自己的唾液。在吞钡检查中，食管上括约肌下方有一柱造影剂，放射科医生将其误诊为巨大ZD。通过在透视下经导丝插管进行内镜球囊扩张成功处理了由此导致的狭窄。ZD采用柔性内镜夹辅助憩室切开术进行治疗。医源性黏膜下剥离是上消化道内镜检查的一种独特并发症。内镜医师、耳鼻喉科医生、放射科医生和心胸外科医生应了解这种情况并准备好进行适当处理。如果患者情况稳定且穿孔可能性较小，可首先尝试保守和支持治疗。可放置手术胃造瘘管进行肠内喂养。对于患有ZD的患者，强烈建议在食管插管期间识别ZD并轻柔操作。
