An esophageal perforation is one of the most fatal clinical events, with a mortality rate of up to 21%. This may arise postoperatively or post-endoscopically. In the past, surgical treatment, such as an esophagectomy, was performed these cases. However, the procedure was challenging and had a high risk of postoperative complications. Recently, advancements in endoscopic techniques have been made, and endoscopic procedures became a common treatment modality for patients with esophageal perforation, even in those with underlying diseases. Among the endoscopic procedures, endoscopic vacuum-assisted closure (E-VAC) has been known to be safe and effective. We present the case of a 64-year-old female with advanced liver cirrhosis and an overtube-induced esophageal perforation during esophageal variceal ligation. She was successfully treated with E-VAC.

A left gastric artery (LGA) pseudoaneurysm is known to occur as a complication of abdominal surgery, trauma, or pancreatitis. However, an LGA pseudoaneurysm presenting with gastrointestinal bleeding is rare. A 77-year-old man complained of dizziness and three episodes of melena in the last 24 hours. He did not have a history of surgery, trauma, or pancreatitis. He underwent primary coronary intervention for unstable angina and started dual antiplatelet therapy 1 month prior. Esophagogastroduodenoscopy (EGD) revealed a 3-cm ulcer in the lesser curvature of the gastric high body with a pulsating subepithelial tumor-like lesion in the ulcer. Hemostasis was achieved endoscopically. Three days after the endoscopic hemostasis, hematemesis and hypovolemic shock occurred. Emergent angiography of the superior mesenteric artery revealed an LGA pseudoaneurysm with extravasation. Coil embolization was successfully performed. Three days after the angiographic embolization, EGD revealed improvement of the gastric ulcer, which was covered with exudate, and disappearance of the subepithelial tumor-like lesion. At the 2-month follow-up, EGD showed that the ulcer was in the healing stage.

No abstract available.
Gastroparesis*

Percutaneous endoscopic gastrostomy (PEG) has substituted surgical gastrostomy for long-term enteral nutrition. Percutaneous endoscopic transgastric jejunostomy (PEG-J) entails placing a feeding tube into the jejunum through PEG. Unlike PEG, PEG-J is associated with complications caused by the jejunal extension tube. Herein, we report a rare complication of PEG-J. A 71-year-old woman who underwent PEG-J for the administration of carbidopa-levodopa, complained of epigastric pain, dyspepsia, and weight loss of more than 10% in 2 months. Esophagogastroduodenoscopy revealed a duodenal decubitus ulcer caused by the pressure from the jejunal extension tube. After removal of the PEG-J and a 4-week treatment with a proton pump inhibitor, the ulcer healed and the symptoms resolved.

Percutaneous endoscopic gastrostomy (PEG) has substituted surgical gastrostomy for long-term enteral nutrition. Percutaneous endoscopic transgastric jejunostomy (PEG-J) entails placing a feeding tube into the jejunum through PEG. Unlike PEG, PEG-J is associated with complications caused by the jejunal extension tube. Herein, we report a rare complication of PEG-J. A 71-year-old woman who underwent PEG-J for the administration of carbidopa-levodopa, complained of epigastric pain, dyspepsia, and weight loss of more than 10% in 2 months. Esophagogastroduodenoscopy revealed a duodenal decubitus ulcer caused by the pressure from the jejunal extension tube. After removal of the PEG-J and a 4-week treatment with a proton pump inhibitor, the ulcer healed and the symptoms resolved.