AIM:To investigate the causes and intraoperative detection of endoscopic retrograde cholangiopancreatography(ERCP)-related perforations to support immediate or early diagnosis.METHODS:Consecutive patients who underwent ERCP procedures at our hospital between January2008 and June 2013 were retrospectively enrolled in the study(n=2674).All procedures had been carried out using digital fluoroscopic assistance with the patient under conscious sedation.For patients showing alterations in the gastrointestinal anatomy,a short-type double balloon enteroscope had been applied.Cases of perforation had been identified by the presence of air in or leakage of contrast medium into the retroperitonealspace,or upon endoscopic detection of an abdominal cavity related to the perforated lumen.For patients with ERCP-related perforations,the data on medical history,endoscopic findings,radiologic findings,diagnostic methods,management,and clinical outcomes were used for descriptive analysis.RESULTS:Of the 2674 ERCP procedures performed during the 71-mo study period,only six(0.22%)resulted in perforations(male/female,2/4;median age:84 years;age range:57-97 years).The cases included an endoscope-related duodenal perforation,two periampullary perforations related to endoscopic sphincterotomy,two periampullary perforations related to endoscopic papillary balloon dilation,and a periampullary or bile duct perforation secondary to endoscopic instrument trauma.No cases of guidewire-related perforation occurred.The video endoscope system employed in all procedures was only able to immediately detect the endoscope-related perforation;the other five perforation cases were all detected by subsequent digital fluoroscope applied intraoperatively(at a median post-ERCP intervention time of 15 min).Three out of the six total perforation cases,including the single case of endoscope-related duodenal injury,were surgically treated;the remaining three cases were treated with conservative management,including trans-arterial embolization to control the blee
Endoscopic submucosal dissection (ESD) with a knife is a technically demanding procedure associated with a high complication rate.The shortcomings of this method are the deficiencies of fixing the knife to the target lesion,and of compressing it.These shortcomings can lead to major complications such as perforation and bleeding.To reduce the risk of complications related to ESD,we developed a new grasping type scissors forceps (Clutch Cutter,Fujifilm,Japan) which can grasp and incise the targeted tissue using an electrosurgical current.Esophagogastroduodenoscopy on a 59-year-old Japanese man revealed a 16mm esophageal submucosal nodule with central depression.Endoscopic ultrasonography demonstrated a hypoechoic solid tumor limited to the submucosa without lymph node involvement.The histologic diagnosis of the specimen obtained by biopsy was granular cell tumor.It was safely and accurately resected without unexpected incision by ESD using the CC.No delayed hemorrhage or perforation occurred.Histological examination confirmed that the granular cell tumor was completely excised with negative resection margin.We report herein a case of esophageal granular cell tumor successfully treated by an ESD technique using the CC.
