Surgical and nonsurgical management of perforation complicating endoscopic submucosal dissection of esophageal cancer: Report of three cases

Perforation of the esophagus during endoscopic therapy is a severe complicati1on. Nonetheless, almost all perforations made during endoscopic submucosal dissection can be treated conservatively because their early diagnosis, the good condition of the patient, and their small size enables them to be closed with endoscopic clips. If inflammation around the esophagus progresses to mediastinitis, however, surgical management such as debridement and drainage should be applied without delay. Here we report three cases of esophageal perforation during endoscopic submucosal dissection that were successfully treated: in case 1, by drainage of the mediastinal abscess under thoracoscopy; in case 2, by mediastinal drainage from the cervix; and in case 3, by application of endoscopic clips. These techniques are effective and less invasive than other surgical approaches. © 2008 Japan Esophageal Soceity and Springer.