Gastric barotrauma induced by Sellick-maneuver performed to enable endoscopic submucosal dissection.

A 55-year-old male underwent endoscopic submucosal dissection (ESD), under general anesthesia and orotracheal intubation, of a 22 mm Paris 0-IIa+0-IIb lesion, located in the greater curvature of the medium/distal antrum (A). It was not possible to start the procedure, after several attempts, due to permanent belching and inability to maintain adequate gastric distension. ESD was only feasible after performing the Sellick-maneuver (manual pressure application at the cricoid cartilage to occlude the upper esophagus), which allowed sustained gastric distension throughout the procedure (60 minutes). At the end, a very large, oozing mucosal laceration, extending from the lesser curvature of the body to the cardia, consistent with gastric barotrauma, was detected (B). Hemostasis was achieved using forceps coagulation and the laceration was completely closed with through-the-scope clips (C). The postprocedure course was uneventful. Histopathologic assessment revealed a low grade dysplasia, R0-resection. Sellick-maneuver, described to avoid tracheobronchial aspiration during orotracheal intubation, has been adapted to prevent gastric deflation during esophagogastroduodenoscopy. A prolonged Sellick-maneuver in this patient induced gastric barotrauma, a rare phenomenon related to increased gastric wall pressure. We report a potentially severe complication of this maneuver which raises awareness of the need to avoid prolonged uncontrolled gastric overinflation during endoscopic procedures.