Description of Event or Problem · 1
THE PATIENT IS A MAN APPROXIMATELY (B)(6) WITH BARRETT'S ESOPHAGUS WITH HIGH- AND LOW-GRADE DYSPLASIA. HE WAS TREATED INITIALLY WITH RADIOFREQUENCY ABLATION BUT HAD PERSISTENT LOW-GRADE DYSPLASIA JUST BELOW THE GASTROESOPHAGEAL JUNCTION. UPPER ENDOSCOPY WITH LIQUID NITROGEN SPRAY CRYOTHERAPY WAS PERFORMED ON (B)(6) 2019. A STANDARD UPPER ENDOSCOPE WAS USED, AND CO2 INSUFFLATION WAS USED THROUGHOUT THE PROCEDURE. AFTER INITIAL ENDOSCOPY WAS PERFORMED, A WIRE WAS PASSED AND A 16 FRENCH OROGASTRIC DECOMPRESSION TUBE WAS PLACED UNEVENTFULLY AND TAPED TO THE PATIENT'S PILLOW. AN ACTIVE VENTING CATHETER WAS USED. A NURSE MONITORED THE ABDOMEN THROUGHOUT THE CRYOTHERAPY. THE CATHETER AND CONSOLE FUNCTIONED NORMALLY THROUGHOUT THE PROCEDURE, AND THE SUCTION ALARM WAS NEVER TRIGGERED. A 20 SECOND CRYOTHERAPY SPRAY WAS PERFORMED UNEVENTFULLY, AND THE TISSUE WAS ALLOWED TO THAW. AFTER 10 SECONDS OF THE SECOND SPRAY, THE PATIENT'S ABDOMEN BECAME VERY DISTENDED AND CRYOTHERAPY WAS HALTED IMMEDIATELY. THE CRYODE COMPRESSION TUBE WAS REMOVED, AND NO BENDS OR KINKS WERE NOTED. ON REPEAT EGD, THE ESOPHAGUS WAS NORMAL, HOWEVER A 2 CM PERFORATION WAS NOTED IN THE POSTERIOR GASTRIC CARDIA. ABDOMINAL DECOMPRESSION WAS PERFORMED SUCCESSFULLY WITH A PARACENTESIS NEEDLE. ENDOSCOPIC SUTURING CLOSED THE PERFORATION SUCCESSFULLY, AND THE PATIENT WAS ADMITTED TO THE HOSPITAL WITH ABDOMINAL DISCOMFORT AND TREATED WITH IV ANTIBIOTICS. THE FOLLOWING DAY, A GASTROGRAFFIN UPPER GI SERIES SHOWED NO LEAK. HE WAS GIVEN A CLEAR LIQUID DIET THE NEXT EVENING AND DISCHARGED ON HOSPITAL DAY 4 WITHOUT COMPLICATION.