Successful management of esophageal perforation using a removable self-expanding covered metallic stent after endoscopic submucosal dissection for a patient with a history of gastrectomy

Abstract

An 81-year-old man with esophageal perforation after endoscopic submucosal dissection, who had a history of distal gastrectomy and had undergone endoscopic submucosal dissection for high-grade intraepithelial dysplasia at another hospital, suddenly developed epigastric pain at night after vomiting. Computed tomography showed pneumomediastinum and bilateral pleural effusions indicating esophageal perforation. The initial doctor referred the patient to our department. On arrival, the patient was in septic shock with acute respiratory failure. It was considered that he was unable to undergo aggressive surgical treatment safely, and a stent with a silicone cover and check valve was placed. Drainage tubes were then inserted into the mediastinum and each thoracic cavity, and a double elementary diet tube was inserted for nutrition and decompression of the stomach. The stent was removed on the 26th day, and the perforation was cured. Stent insertion is a useful treatment for the patient with serious esophageal perforation after ESD with a history of gastrectomy.

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