Abstract
Procedure-related complications of gastric endoscopic submucosal dissection (ESD) mainly include bleeding and perforation. Another complication is stricture formation after ESD close to the pylorus or close to the gastroesophageal junction. We report a case of an 86-year-old patient who developed extensive gastric ischemia after ESD for early gastric cancer. We suppose that the most likely reason for the ischemia was the submucosal injection of a large volume of a mixture of glycerol (10%) and epinephrine (dilution 1: 50 000) that was used, in combination with the patient’s underlying cardiovascular comorbidity. Gastric ischemia as a complication of gastric ESD has not been described previously. A conservative treatment approach seems justifiable. However, close endoscopic follow up for early recognition and treatment of a resulting stricture is recommended.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Gotoda T. Endoscopic resection of early gastric cancer. Gastric Cancer 2007;10:1–11.
Coda S, Oda I, Gotoda T, Yokoi C, Kikuchi T, Ono H. Risk factors for cardiac and pyloric stenosis after endoscopic submucosal dissection, and efficacy of endoscopic balloon dilation treatment. Endoscopy 2009;41:421–426.
Wheeldon NM, Grundman MJ. Ischemic colitis as a complication of colonoscopy. BMJ 1990;301:1080–1081.
Dorta G, Michetti P, Burckhardt P, Gillet M. Acute ischemia followed by hemorrhagic gastric necrosis after injection sclerotherapy for ulcer. Endoscopy 1996;28:532.
Goldberg PA, Krige JE. Fatal gastroduodenal necrosis after injection sclerotherapy for bleeding duodenal ulcer. J Clin Gastroenterol 1993;16:136–138.
Cappelii J, Dryjski J, Rahier I, Ramdani B, Lamy V, Moisse R. Another severe complication of sclerotherapy for bleeding peptic ulcer. Endoscopy 1993;25:431–432.
Loperfido S, Patelli G, La Torre L. Extensive necrosis of gastric mucosa following injection therapy of bleeding peptic ulcer. Endoscopy 1990;22:285–286.
Cheah WK, So J, Chong SM, Goh P. Duodenal ulcer perforation following cyanoacrylate injection. Endoscopy 2000;32:S23.
Uraoka T, Fujii T, Saito Y, Sumiyoshi T, Emura F, Bhandari P, et al. Effectiveness of glycerol as a submucosal injection for EMR. Gastrointest Endosc 2005;61:736–740.
Fujishiro M, Yahagi N, Kashimura K, Matsuura T, Nakamura M, Kakushima M, et al. Tissue damage of different submucosal injection solutions for EMR. Gastrointest Endosc 2005;62: 933–942.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Probst, A., Maerkl, B., Bittinger, M. et al. Gastric ischemia following endoscopic submucosal dissection of early gastric cancer. Gastric Cancer 13, 58–61 (2010). https://doi.org/10.1007/s10120-009-0539-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10120-009-0539-2