A case of temporary cardiac arrest during endscopic submucosal dissection for surperficial esophageal cancer with sick sinus syndrome

症例は70歳代前半の男性.中部食道の表在型食道癌に対し,内視鏡的粘膜下層剥離術(endscopic submucosal dissection, ESD)を施行した.術中に頻脈･高血圧を認め,適宜ニカルジピン投与で対応していたところ,突然一過性の心停止を認めた.心マッサージを行うことにより速やかに心拍再開し,循環器内科医師の来診後,経皮ペーシング準備の元でESDを続行し,病変を一括切除し得た.術後施行したHolter心電図では洞不全症候群の診断であった.本症例は,食道ESD術中のエピネフリン局注が頻脈･高血圧に関係したと推定され,ニカルジピン投与後に洞不全症候群による一過性の心停止を来した,稀な症例と考えられた.

The case is a male in his early seventies. We performed endoscopic submucosal dissection(ESD)for superficial esophageal cancer in the mid-esophagus. During procedure, the patient exhibited tachycardia and hypertension, and when treated with nicardipine for the same, he suddenly went into temporary cardiac arrest. His heart was quickly restarted by performing cardiac massage. Subsequently, under the observation of a cardiovascular internist ready for transcutaneous pacing, the procedure was continued and the lesion completely resected. On using a Holter electrocardiogram postoperatively, the patient was diagnosed with sick sinus syndrome. We hypothesize that the submucosal epinephrine injection administered during esophageal ESD was related to the tachycardia and hypertension, and we consider this is a rare case of esophageal ESD during which cardiac arrest due to sick sinus syndrome occurred after nicardipine administration.

ESD

表在型食道癌

心停止

洞不全症候群