Delayed perforation after endoscopic submucosal dissection for early gastric cancer: Clinical features and treatment

Figure 1 Endoscopic submucosal dissection. A: Findings on upper gastrointestinal endoscopy (conventional examination). Patient 2 had delayed perforation after undergoing endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). 0-IIc lesions were found in the anterior and posterior walls of the greater curvature at the gastric angle (circles); B: Findings after ESD. Patient 2 had delayed perforation after ESD for EGC. The 2 lesions were adjacent. The ulcer floor had fused together.

Figure 2 Radiography and abdominal computed tomography. A: A chest radiograph, showing free air below the right diaphragm (arrow); B: An abdominal computed tomography scan, showing free air (arrow).

Figure 3 Muscular layer had become necrotic. A: The surgically resected specimen. Although no distinct site of perforation was found in the surgically resected specimen, the ulcer floor had become thin after endoscopic submucosal dissection (circled); B: The histopathological specimen stained with hematoxylin and eosin. At the ulcer floor, the muscular layer was exposed, and all layers had become necrotic.