Kelly R Haisley, MD, Kevin Reavs, MD, Michael Antiporda, MD, Walaa Abdelmoaty, MD, MBA, Missy Desouza, MD, Christy Dunst, MD, Lee Swanstrom. Providence Portland Medical Center
Introduction: In this video, we review a case of the complex endoscopic removal of a large esophageal leiomyoma by a submucosal resection technique extending into the mediastinum.
Background: The patient is a healthy 38 year old woman with dysphagia, found to have a 2.5 by 4 centimeter mass in the mid esophagus consistent with a benign esophageal leiomyoma. Knowing that the typical upper limit for endoscopic resection of esophageal masses such as this has been around 4cm, a long discussion was held with the patient and care team about the feasibility of an endoscopic resection of this larger mass. Ultimately, given the apparent favorable characteristics of the mass and patient, the decision was made to proceed to the operating room for endoscopic resection of the leiomyoma.
Methods: The video that follows demonstrates an endoscopic submucosal approach with a full thickness esophageal wall resection to remove the mass, which was ultimately found to be much larger than initially anticipated and extending into the mediastinum.
Conclusion: The success of this case illustrates that larger benign esophageal masses can be successfully approached endoscopically. However, It should also be noted that such cases are very technically challenging, and can be harder than anticipated, as was the case here in which our pre-operative imaging studies had underappreciated the extent of muscle and mediastinal involvement that required resection and made the removal of the mass more challenging. To approach such a case safely requires an experienced endoscopic team as well as an immediately available backup approach in case of complications. However, an endoscopic approach does offer a potential route for resection of masses that would traditionally have required a transthoracic approach, offering lower morbidity and less invasive options for appropriately selected patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94706
Program Number: V074
Presentation Session: Plenary I
Presentation Type: Video
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