Gastric ischemia following endoscopic submucosal dissection of early gastric cancer

Procedure-related complications of gastric endoscopic submucosal dissection (ESD) mainly include bleeding and perforation. Another complication is stricture formation after ESD close to the pylorus or close to the gastroesophageal junction. We report a case of an 86-year-old patient who developed extensive gastric ischemia after ESD for early gastric cancer. We suppose that the most likely reason for the ischemia was the submucosal injection of a large volume of a mixture of glycerol (10%) and epinephrine (dilution 1: 50 000) that was used, in combination with the patient's underlying cardiovascular comorbidity. Gastric ischemia as a complication of gastric ESD has not been described previously. A conservative treatment approach seems justifiable. However, close endoscopic follow up for early recognition and treatment of a resulting stricture is recommended.