PYOPNEUMOTHORAX AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION PERFORMED WITH THE PATIENT IN THE RIGHT LATERAL POSITION FOR EARLY GASTRIC CANCER OF THE FORNIX

Abstract

An 80-year-old man consulted a primary care physician for medical checkup. Esophagogastroduodenoscopy (EGD) demonstrated an elevated lesion at the fornix of the stomach and he was referred to our hospital for further investigation. The lesion was diagnosed as early gastric cancer and endoscopic submucosal dissection (ESD) was performed. While the patient was in the left lateral position, it was difficult to approach the lesion tangentially with the endoscope. Therefore, we performed ESD with the patient in the right lateral position with an over-tube. On the first postoperative day, the patient developed a high-grade fever and respiratory failure. Computed tomography (CT) demonstrated a right pyopneumothorax and aspiration pneumonia. He recovered with antibiotics, steroids and thoracic drainage. We reported the efficacy of ESD with the patient in the right lateral position for early gastric cancer at the fornix. However, this position may induce severe respiratory infections.