title: Mallory-Weiss tear during gastric endoscopic submucosal dissection.
abstract: A 78-year-old woman was referred to our department for treatment of an early gastric cancer. Esophagogastroduodenoscopy (EGD) demonstrated a flat elevated lesion and a polypoid lesion on the greater curvature of the antrum. Histological analysis of, endoscopic biopsy samples taken from these lesions revealed an adenocarcinoma and a hyperplastic polyp, respectively. ESD was conducted for removal of the lesions. Carbon dioxide (CO(2)) instead of room air was used for insufflation, and the patient was adequately sedated without struggling or vomiting during the treatment. No significant bleeding from the lesion was observed during ESD, but fresh blood was identified endoscopically. Surprisingly, a Mallory-Weiss tear with active bleeding was detected on the lesser curvature of the gastric corpus. A total of eight hemoclips were applied for hemostasis. Both lesions were completely removed en bloc, and no bleeding or perforation developed after ESD. Histologically, the first lesion was a papillary carcinoma limited to the mucosal layer and without lymphovascular invasion or involvement of the surgical margins, while the second lesion was a benign hyperplastic polyp.
authors.affiliation: Hiroki Hongou, Kuangi Fu, Hiroya Ueyama, Taiji Takahashi, Tsutomu Takeda, Akihisa Miyazaki, Department of Gastroenterology, Juntendo University Nerima Hospital, Nerima, Tokyo 177-0033, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hongou
authors.forename: Kuangi
authors.initials: K
authors.lastname: Fu
authors.forename: Hiroya
authors.initials: H
authors.lastname: Ueyama
authors.forename: Taiji
authors.initials: T
authors.lastname: Takahashi
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Takeda
authors.forename: Akihisa
authors.initials: A
authors.lastname: Miyazaki
authors.forename: Sumio
authors.initials: S
authors.lastname: Watanabe