Mario Masrur, MD1, Luis F Gonzalez-Ciccarelli, MD1, Pablo Quadri, MD1, M. Di Cicco, MD2, A. Rosales, MD2, L. Miranda, MD2, J. Isaguirre, MD2. 1University of Illinois at Chicago, 2Hospital Italiano de Mendoza
Introduction: Leiomyomas are the most common mesenchymal tumors of the esophagus but are exceedingly rare in other parts of the GI tract. The general consensus in the literature is that esophageal leiomyomas should be removed in symptomatic patients. Surgical treatment has traditionally been the therapy of choice, but endoscopic approach may be indicated in tumors that originate in the muscularis propia and grow in an intraluminal pattern
Case presentation: Patient was a 55-year-old man who presented with dysphagia and gastroesophageal reflux symptoms. An upper GI fluoroscopy was performed showing a lesion in the lower third of the esophagus with proximal dilation. EGD showed a 4 cm subepithelial lesion in the distal esophagus with negative biopsies. Endoscopic ultrasound showed a 43×38 mm hypoechoic heterogeneous submucosal lesion suggestive of gastrointestinal stromal tumor versus leiomiosarcoma. A new biopsy with mucosal opening was performed with the histopathological diagnosis of leiomyoma. The patient was then offered the option of undergoing an endoscopic resection with tunelization technique.The procedure was performed under general anesthesia. Saline solution containing methylene blue and adrenaline was injected in the esophageal wall to facilitate submucosal dissection. A mucosal incision was performed 10 cm proximal to the tumor. A submucosal tunnel was created dissecting the esophageal wall distally to reach the tumor. The latter seemed to be dependent on the muscularis propia. The tumor was dissected using a monopolar probe and blunt dissection with the overhead endoscopic tube. Once the tumor was completely freed form the esophageal wall it was removed using an endoscopic snare. The esophageal mucosal wall was closed with endoclips. The overall procedure time was 120 min. The patient presented mediastinal and subcutaneous emphysema after the procedure which was managed with a chest tube removed after 3 days. Discharged was on POD 7. The patient’s symptoms improved dramatically after surgery. At 2 years follow up the patient remained asymptomatic with a normal CT scan.
Conclusions: In this case report, an endoscopic resection of this subepithelial esophagic distal leiomyoma was safe and feasible with low morbidity. This approach could be an alternative to surgery in centers with highly skilled endoscopic teams.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80433
Program Number: V083
Presentation Session: Friday Exhibit Hall Video Presentations Session 2 (Non CME)
Presentation Type: EHVideo
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