An unusual cause of dysphagia after endoscopic resection of an early esophageal cancer
An unusual cause of dysphagia after endoscopic resection of an early esophageal cancer
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早期食管癌内镜切除术后吞咽困难的一个不寻常原因
DOI：
10.1055/s-0030-1256260
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发表时间：
2011
期刊：
影响因子：
9.3
通讯作者：
Chiba T
中科院分区：
文献类型：
--
作者：
Nakanishi Y;Miyamoto S;Ishizu S;Seno H;Muto M;Chiba T
一位72岁的男性被转介到我们医院进行内镜治疗的早期食管癌。他已经知道了30年的食管中段粘膜下肿瘤（SMT）。内窥镜检查显示癌位于表面并已向远端扩散（[图1]）[1]。SMT在计算机断层扫描（CT）上显示为高强度肿块，表明它几乎完全高度钙化。由于CT扫描显示SMT位于主动脉附近（[图2]），因此仅通过内镜粘膜下剥离术（ESD）切除癌性部分，而SMT的其余部分未受影响（[图3]）[2]。尽管手术完成且无并发症，但3个月后患者主诉吞咽困难。内窥镜检查显示食管腔内有一个巨大肿块（[图4]），通过狭窄的蒂附着在ESD瘢痕上。我们认为肿块是原来的SMT，在修复粘膜缺损后暴露于食管腔。我们用圈套器切断了蒂部;然而，由于肿瘤尺寸较大，我们无法通过患者的口腔切除肿瘤。由于肿瘤的硬度太大，我们使用了几种内窥镜器械，包括机械碎石术和电液碎石术，都未能成功破坏肿瘤。幸运的是，肿瘤最终通过肛门排出，没有造成肠梗阻。然而，我们错过了从粪便中取出肿瘤，因此无法进行组织病理学检查。随访内窥镜检查仅显示食管溃疡瘢痕，无任何复发或狭窄形成（[图5]）。
A 72-year-old man was referred to our hospital for endoscopic treatment of an early esophageal cancer. He had been aware of a submucosal tumor (SMT) in the mid-esophagus for 30 years. Endoscopy revealed that the cancer was located on the surface and had spread distally ([Fig. 1])[1]. The SMT was visualized as a high-intensity mass on computed tomography (CT), suggesting that it was almost entirely highly calcified. Because the CT scan showed that the SMT was located adjacent to the aorta ([Fig. 2]), only the cancerous part was resected by endoscopic submucosal dissection (ESD), leaving the rest of the SMT untouched ([Fig. 3])[2]. Although the procedure was completed without complications, 3 months later the patient complained of dysphagia. Endoscopy revealed a giant mass in the esophageal lumen ([Fig. 4]), attached via a narrow pedicle to the ESD scar. We recognized the mass as the original SMT, which had become exposed to the esophageal lumen after the mucosal defect had been repaired. We severed the pedicle with a snare; however, because of its large size, we were unable to remove the tumor through the patient’s mouth. We then failed to disrupt the tumor using several endoscopic devices, including mechanical lithotripsy and electrohydraulic lithotripsy, because of its marked hardness. Fortunately, the tumor was eventually expelled through the anus without causing intestinal obstruction. However, we missed retrieving the tumor from the feces so a histopathologic examination could not be done. Follow-up endoscopy showed only an esophageal ulcer scar without any recurrence or stricture formation ([Fig. 5]).