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A 60-year-old man with early esophageal squamous cell carcinoma underwent ESD, during which a translucent, respiration-synchronized muscularis propria defect was incidentally recognized after perforation. Endoscopic endoclip-nylon loop purse-string closure achieved successful treatment. The patient recovered without complications, with negative pathologic margins and no diverticulum or stenosis at 3-month follow-up endoscopy, supporting timely recognition and conservative management.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/congenital-esophageal-muscularis-propria-defect-a-case-report-and-management/437299/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/congenital-esophageal-muscularis-propria-defect-a-case-report-and-management/437299.png","ImageObject",300,407,{"name":92,"@type":93},"McQueen","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What condition was incidentally found during the ESD procedure?","Question",{"text":112,"@type":113},"A congenital esophageal muscularis propria defect was incidentally identified intraoperatively as a translucent submucosal membrane that pulsated synchronously with respiration.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was the defect managed after perforation occurred?",{"text":117,"@type":113},"After accidental rupture and perforation of the membrane, the team performed an endoscopic endoclip-nylon loop purse-string closure to achieve complete sealing.",{"name":119,"@type":110,"acceptedAnswer":120},"What were the key follow-up outcomes after treatment?",{"text":121,"@type":113},"The patient recovered uneventfully, and follow-up endoscopy at 3 months showed no diverticulum or stenosis, with pathologically confirmed negative margins.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},437299,1790718778,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":52,"preview_page_count":4},5909890329169,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","DEN Open  \nCASE REPORT   \nCongenital Esophageal Muscularis Propria Defect Found during Endoscopic Submucosal Dissection for Early Esophageal Cancer: A Case Report and Management  \nYing Liu1  Yuhan Ren1  Fan Wang1  Wei Cao1  Yanqin Long2   \n1 Department of Gastroenterology, Renmin Hospital, Hubei University of Medicine, Shiyan, China  2 Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China  \nCorrespondence: Ying Liu ([lying0508@163.com](lying0508@163.com))  Yanqin Long (longyanqin0910@163.com)  \nReceived: 18 November 2025  Revised: 25 December 2025  Accepted: 26 December 2025  \nKeywords: congenital | endoscopic submucosal dissection | esophageal | muscularis propria defects | perforation  \nABSTRACT  \nCongenital esophageal muscularis propria defects are extremely rare, often complicating endoscopic submucosal dissection (ESD) for esophageal neoplasms. We report a 60-year-old man with early esophageal squamous cell carcinoma who underwent ESD. Intraoperatively, a congenital muscularis propria defect was incidentally identified as a translucent, respiration-synchronized submucosal membrane, which exposed mediastinal structures after perforation. The defect was successfully managed via endoscopic endoclip-nylon loop purse-string closure. The patient recovered uneventfully, with pathologically confirmed negative margins and no diverticulum or stenosis at 3-month follow-up endoscopy. This case highlights that timely endoscopic recognition and management of such defects during ESD can avoid surgical intervention and ensure favorable outcomes, providing practical insights for endoscopists.  \n1  Introduction  \nCongenital esophageal muscularis propria defects are extremely rare, with only sporadic cases reported in Japan, most incidentally detected during endoscopic submucosal dissection (ESD) for superficial early esophageal neoplasms [1–7] . ESD carries elevated iatrogenic perforation risk in such cases, several previous cases required surgical intervention due to endoscopic management challenges. We report a successfully endoscopically managed case, highlighting key endoscopic features and the feasibility of conservative endoscopic treatment to guide practicing endoscopists.  \n2  Case Report  \nA 60-year-old male farmer presented with dysphagia for over one month and had no history of previous illness, trauma, or surgery. Endoscopy revealed a 2-cm diameter flat mucosal lesion (slight roughness and erythema) on the right side of the mid-thoracic esophagus (∼30 cm from incisors), biopsy confirmed highgrade intraepithelial neoplasia. Preoperative evaluations, including routine blood tests and chest computed tomography (CT), were unremarkable, with no esophageal diverticulum identified. Under general anesthesia, ESD was performed using a singlechannel endoscope (GIF-Q260J; Olympus, Tokyo, Japan), a Dual  \n\n| Ying Liu and Yuhan Ren contributed equally.\u003Cbr>|\n| --- |\n| This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.\u003Cbr>© 2026 The Author(s). DEN Open published by John Wiley & Sons Australia, Ltd on behalf of Japan Gastroenterological Endoscopy Society. |\n\nDEN Open, 2026; 6:e70274  \n[https://doi.org/10.1002/deo2.70274](https://doi.org/10.1002/deo2.70274)  \n1 of 4  \nFIGURE 1  (a) Endoscopic view showing Lugol’s iodine staining of the mucosal lesion in the mid-thoracic esophagus (∼30 cm from incisors) . The unstained area indicates suspicious mucosa. (b) Endoscopic view of the post-endoscopic submucosal dissection (post-ESD) wound bed following complete en bloc resection. Note the exposed submucosal layer and the muscularis propria defect (arrow) . (c) A translucent membranous area in the submucosa was observed, pulsating synchronously with respiration (arrow) . (d) Endoscopic view showing perforation of the translucent membrane (a","cbCaif8imIQExDmn","https://ap.wps.com/l/cbCaif8imIQExDmn","pdf",6012687,"English","# Introduction\n# Case Report","[{\"question\":\"What condition was incidentally found during the ESD procedure?\",\"answer\":\"A congenital esophageal muscularis propria defect was incidentally identified intraoperatively as a translucent submucosal membrane that pulsated synchronously with respiration.\"},{\"question\":\"How was the defect managed after perforation occurred?\",\"answer\":\"After accidental rupture and perforation of the membrane, the team performed an endoscopic endoclip-nylon loop purse-string closure to achieve complete sealing.\"},{\"question\":\"What were the key follow-up outcomes after treatment?\",\"answer\":\"The patient recovered uneventfully, and follow-up endoscopy at 3 months showed no diverticulum or stenosis, with pathologically confirmed negative margins.\"}]","Congenital Esophageal Muscularis Propria Defect - A Case Report and Management | PDF",1790680997]