Iatrogenic esophageal submucosal dissection after attempted diagnostic gastroscopy (with videos)

Shou Jiang Tang, Linda Tang, Saad F. Jazrawi, Dan Meyer, Michael A. Wait, Larry L. Myers

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Diagnostic esophagogastroduodenoscopy (EGD) is generally a very safe procedure. We report the first case of iatrogenic esophageal submucosal dissection after an attempted diagnostic gastroscopy in a patient with a small previously undiagnosed Zenker's diverticulum (ZD). After EGD, she developed severe dysphagia with the inability to swallow solids, liquids, and even her own saliva. On barium swallow study, there was a column of contrast below the upper esophageal sphincter, and this was misdiagnosed as a large ZD by the radiologist. The resultant stricture was successfully managed with endoscopic balloon dilatation under fluoroscopy with wire-guided cannulation. The ZD was treated with flexible endoscopic clip-assisted diverticulotomy. Iatrogenic submucosal dissection is a unique complication of upper endoscopy. Endoscopists, otolaryngologists, radiologists, and cardiothoracic surgeons should be aware of this condition and prepare to manage it appropriately. If the patient is stable and the possibility of perforation is small, conservative and supportive care can be tried first. A surgical gastrostomy tube can be placed for enteral feeding. In patients with ZD, ZD recognition and gentle manipulation is strongly recommended during esophageal intubation.

Original languageEnglish (US)
Pages (from-to)36-38
Number of pages3
JournalLaryngoscope
Volume119
Issue number1
DOIs
StatePublished - Jan 2009

Fingerprint

Zenker Diverticulum
Gastroscopy
Dissection
Digestive System Endoscopy
Deglutition
Upper Esophageal Sphincter
Gastrostomy
Fluoroscopy
Enteral Nutrition
Barium
Deglutition Disorders
Diagnostic Errors
Saliva
Surgical Instruments
Intubation
Catheterization
Endoscopy
Dilatation
Pathologic Constriction

Keywords

  • Endoscopic clip-assisted diverticulotomy (ecd)
  • Esophagogastroduodenoscopy
  • Esophagus
  • Stricture
  • Submucosal dissection
  • Zenker's diverticulum

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Medicine(all)

Cite this

Iatrogenic esophageal submucosal dissection after attempted diagnostic gastroscopy (with videos). / Tang, Shou Jiang; Tang, Linda; Jazrawi, Saad F.; Meyer, Dan; Wait, Michael A.; Myers, Larry L.

In: Laryngoscope, Vol. 119, No. 1, 01.2009, p. 36-38.

Research output: Contribution to journalArticle

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