During an endoscopic submucosal dissection (esd) procedure, the physician used a cook gel kit.The physician reported a complication during the esd case using the gel kit on a lesion located at the gastro-esophageal junction.Initial injection of saline was performed as practiced in other area of gi tract.Then, gel was injected at gastro-esophageal junction with bleb on straight view.During the case, he noticed some pockets created by the gel.They looked like they were created within submucosa but appeared deep.When he cut into the submucosal space near the pockets, he realized that they were formed within the muscularis propria as he could visualize the serosa.It was noted that the muscle was split and this caused pain to the patient.The deep pocket appeared not to have penetrated the serosa.At the end of the completed resection, clips and endoscopic sutures were placed to prevent delayed perforation and a stent was placed.A section of the device did not remain inside the patient's body.The injection into the muscle was painful to the patient.The patient required clips, sutures and a stent due to this occurrence.The patient was observed for 2 days and then discharged.The patient did not require any other additional procedures due to this occurrence.According to the initial reporter, the patient did no experience any adverse effects due to this occurrence.
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