Seehawong Umaporn, Morita Yoshinori, Nakano Yoshiko, Iwasaki Takehiro, Krutsri Chonlada, Sakaguchi Hiroya, Sako Tomoya, Takao Toshitatsu, Tanaka Shinwa, Toyonaga Takashi, Umegaki Eiji, Kodama Yuzo
Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan.
Clin J Gastroenterol. 2019 Feb;12(1):29-33. doi: 10.1007/s12328-018-0900-2. Epub 2018 Aug 31.
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.
一名74岁女性，被诊断为浅表性食管癌，在另一家医院接受了内镜黏膜下剥离术（ESD），但术中发生穿孔。穿孔用内镜夹封闭，ESD手术中止。患者被转诊至我院，再次尝试ESD。病变周围有严重纤维化，向黏膜下层注射困难。此外，无法识别黏膜下层，进行口侧切口时沿切口线出现大穿孔。由于认为使用内镜刀继续进行黏膜下剥离困难，最终使用圈套器通过杂交ESD切除病变。穿孔用聚乙醇酸（PGA）片和纤维蛋白胶封闭。术后6天进行的内镜检查显示缺损已闭合，未检测到造影剂渗漏。ESD术后3个月进行的随访内镜检查显示，剥离部位溃疡愈合且形成瘢痕，但未发现残留肿瘤或食管狭窄。我们的经验表明，使用PGA片联合纤维蛋白胶是治疗ESD术中大型食管穿孔的一种可行、安全且有效的方法。
