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首页> 外文期刊>The Laryngoscope: A Medical Journal for Clinical and Research Contributions in Otolaryngology, Head and Neck Medicine and Surgery, Facial Plastic and Reconstructive Surgery .. >Iatrogenic esophageal submucosal dissection after attempted diagnostic gastroscopy (with videos).
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Iatrogenic esophageal submucosal dissection after attempted diagnostic gastroscopy (with videos).

机译：尝试诊断性胃镜检查后有医源性食管粘膜下剥离术（视频）。

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摘要

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 possibilityof 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.
机译：诊断性食管胃十二指肠镜检查（EGD）通常是非常安全的过程。我们报告了第一例医源性食管粘膜下剥离的病例，该病例在尝试诊断胃镜检查的患者中有一个先前未被诊断的Zenker憩室（ZD）。 EGD后，她严重吞咽困难，无法吞咽固体，液体甚至自己的唾液。在钡吞咽研究中，食管上括约肌下方有一列对比，这被放射科医生误诊为大ZD。所产生的狭窄在线引导下的荧光透视下通过内窥镜球囊扩张术得以成功处理。 ZD用柔性内镜夹钳辅助憩室切开术治疗。医源性粘膜下剥离是上内镜的独特并发症。内镜医师，耳鼻喉科医师，放射科医师和心胸外科医师应了解这种情况，并做好适当处理的准备。如果患者稳定且穿孔的可能性很小，则可以首先尝试保守和支持性护理。可以放置外科胃造口术管进行肠内喂养。对于患有ZD的患者，强烈建议在食管插管过程中对ZD进行识别并进行轻柔的操作。

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