title: Esophageal diverticulum exposed during endoscopic submucosal dissection of superficial cancer.
abstract: Endoscopic submucosal dissection (ESD) is now widely accepted as a strategy to treat superficial esophageal neoplasms. The rate of adverse events, such as perforation, has been decreasing with the improvement of devices and techniques. In this paper, we report a case of esophageal cancer that had a diverticulum under cancerous epithelium. The diverticulum was not detected during preoperative examination, and led to perforation during the ESD procedure. Our case shows that, although rare, some diverticula can exist underneath the mucosal surface without obvious depression. If there is any sign of hidden diverticula during ESD, surgeons should proceed with caution or, depending on the case, the procedure should be discontinued to avoid adverse events.
authors.affiliation: Shinwa Tanaka, Takashi Toyonaga, Tetsuya Yoshizaki, Fumiaki Kawara, Department of Endoscopy, Kobe University, Hyogo 650-0017, Japan.
authors.forename: Shinwa
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Shinwa Tanaka, Takashi Toyonaga, Tetsuya Yoshizaki, Fumiaki Kawara, Department of Endoscopy, Kobe University, Hyogo 650-0017, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Toyonaga
authors.affiliation: Shinwa Tanaka, Takashi Toyonaga, Tetsuya Yoshizaki, Fumiaki Kawara, Department of Endoscopy, Kobe University, Hyogo 650-0017, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Ohara
authors.affiliation: Shinwa Tanaka, Takashi Toyonaga, Tetsuya Yoshizaki, Fumiaki Kawara, Department of Endoscopy, Kobe University, Hyogo 650-0017, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yoshizaki
authors.affiliation: Shinwa Tanaka, Takashi Toyonaga, Tetsuya Yoshizaki, Fumiaki Kawara, Department of Endoscopy, Kobe University, Hyogo 650-0017, Japan.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Kawara
authors.affiliation: Shinwa Tanaka, Takashi Toyonaga, Tetsuya Yoshizaki, Fumiaki Kawara, Department of Endoscopy, Kobe University, Hyogo 650-0017, Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Ishida
authors.affiliation: Shinwa Tanaka, Takashi Toyonaga, Tetsuya Yoshizaki, Fumiaki Kawara, Department of Endoscopy, Kobe University, Hyogo 650-0017, Japan.
authors.forename: Namiko
authors.initials: N
authors.lastname: Hoshi
authors.affiliation: Shinwa Tanaka, Takashi Toyonaga, Tetsuya Yoshizaki, Fumiaki Kawara, Department of Endoscopy, Kobe University, Hyogo 650-0017, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Morita
authors.affiliation: Shinwa Tanaka, Takashi Toyonaga, Tetsuya Yoshizaki, Fumiaki Kawara, Department of Endoscopy, Kobe University, Hyogo 650-0017, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Azuma
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D004210:Dissection / Q000379:methods*; D004936:Diverticulum, Esophageal / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D004939:Esophageal Perforation / Q000209:etiology / Q000601:surgery; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy / Q000379:methods*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008875:Middle Aged; D013525:Surgical Instruments; D013536:Suture Techniques / Q000295:instrumentation; D016896:Treatment Outcome
keywords: Diverticula; Endoscopic submucosal dissection; Esophageal cancer; Perforation