A CASE OF DELAYED PERFORATION OF A GASTRIC ULCER INDUCED BY ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY GASTRIC CANCER

Abstract

Under a follow-up after a treatment of peptic ulcer of the stomach, a 64-year-old male underwent endoscopic submucosal dissection (ESD) for an early gastric cancer at a different site from the ulcer. He was followed by administration of proton pump inhibitor (PPI) for three weeks without symptoms. However he underwent emergency surgery 49 days after the ESD because of perforation at the site of ulceration, induced by the ESD. Despite some findings of healing of the gastric ulcer on the pathology report, the ulcer had reached the muscle layers and perforated. The reason for the delayed perforation was possibly due to the interruption of the PPI, and the effect of the PPI was not enough to decrease acid secretion because the PPI was rapidly metabolized.