Background and Study Aim: The introduction of endoscopic ultrasound (EUS) and endoscopic mucosal resection has offered a new alternative to simple observation or surgical resection for the management of esophageal submucosal tumors.
Patients and Methods: During a 4-year period, endoscopic resection was attempted in 20 consecutive patients (nine women, 11 men; mean age 52 ± 10 years) with esophageal submucosal tumors < 4 cm in size, confirmed by endoscopy and miniprobe EUS (20 MHz). The mean tumor diameter was 17 ± 8 mm (8 - 34 mm). Prior EUS-guided cytological examination revealed benign tumors in 11 patients; however, endoscopic resection was attempted in most patients for diagnostic purposes also. Several patients were symptomatic (retrosternal pain, n = 4; dysphagia, n = 4; recurrent bleeding, n = 2) but most tumors had been detected incidentally.
Results: In the majority of patients the tumor was ligated with a rubber band and then resected with a snare (n = 11), and in the others simple snare resection (”lift-and-cut,” n = 7) or cap resection (n = 2) was done. A macroscopically complete endoscopic resection was achieved in 19/20 patients, and the remaining patient was managed surgically. Endoscopic hemostasis was necessary (and successful) in eight patients (40 %), but blood transfusion was not required. No other side effects occurred. Histological examination revealed granular cell tumor in 12 patients, leiomyoma in six patients, and a lipoma and stromal tumor in one patient each. Histologically, all tumors were judged to be benign and a microscopically complete resection (R0) was achieved in all patients, with the exception of the one patient with a stromal tumor. Thus, surgical resection was necessary in only two of the 20 patients (10 %). During the median prospective follow-up of 12 months no tumor recurrence was detected in any patient.
Conclusion: Endoscopic resection of esophageal submucosal tumors is safe and effective. The probability of achieving curative resection (R0 resection, histologically benign) is high especially if the tumors are smaller in size (< 4 cm).
References
-
1
Seremetis M, Lyons W, DeGuzman V, Peabody J, Jr.
Leiomyoma of the esophagus.
Cancer.
1976;
38
2166-2177
-
2
Fockens P, Bartelsman J, Tytgat G.
Benign and malignant esophageal tumors of the esophagus other than squamous and adenocarcinoma.
Gastrointest Endosc Clin N Am.
1994;
4
791-801
-
3
Dorais J, Marcon N.
Endoscopic resection of gastrointestinal tumors: how far can the endoscopist go?.
Endoscopy.
1997;
29
192-195
-
4
Rösch T, Classen M.
A new ultrasonic probe for endosonographic imaging of the upper GI tract.
Endoscopy.
1990;
20
41-46
-
5
Vilmann P, Hancke S.
Endoscopic ultrasound with guided needle biopsy and color Doppler examination in the upper gastrointestinal tract.
Endoscopy.
1992;
24
656-658
-
6
Giovannini M, Seitz J F, Monges G. et al .
Fine-needle aspiration cytology guided by endoscopic ultrasonography: results in 141 patients.
Endoscopy.
1995;
27
171-177
-
7
Inoue H, Takeshita K, Endo M. et al .
A new simplified technique of endoscopic esophageal mucosal resection using a cap-fitted panendoscope (EMRC).
Surg Endosc.
1992;
6
264-265
-
8
Martin T R, Onstad G R, Silvis S E, Vennes J A.
Lift and cut biopsy technique for submucosal sampling.
Gastrointest Endosc.
1976;
23
29-30
-
9
Karita K, Tada M.
Endoscopic and histologic diagnosis of submucosal tumors of the gastrointestinal tract using combined strip biopsy and bite biopsy.
Gastrointest Endosc.
1994;
40
749-753
-
10
Bardini A, Segalin A, Ruol A. et al .
Videothoracoscopic enucleation of esophageal leiomyoma.
Ann Thorac Surg.
1992;
54
576-577
-
11
Everitt N J, Glinatsis M, McMahon M J.
Thoracoscopic enucleation of leiomyoma of the esophagus.
Br J Surg.
1992;
79
643
-
12
Wolfsohn D M, Savides T F, Easter D W, Lyche K D.
Laparoscopy-assisted endoscopic removal of a stromal tumor of the stomach.
Endoscopy.
1997;
29
679-682
-
13
Tada S, Iida M, Yao T. et al .
Granular cell tumor of the esophagus: endoscopic ultrasonographic demonstration and endoscopic removal.
Am J Gastroenterol.
1990;
85
1507-1511
-
14
Kajiyama T, Sakai M, Kishimoto H. et al .
Endoscopic aspiration lumpectomy of esophageal leiomyomas derived from the muscularis mucosae.
Am J Gastroenterol.
1995;
90
417-422
-
15
Okahara S, Tanaka S, Haruma K.
A case of granular cell tumor of the esophagus resected endoscopically.
J Hiroshima Med Assoc.
1995;
48
810-814
-
16
Yasuda I, Tomita E, Nagura K. et al .
Endoscopic removal of granular cell tumors.
Gastrointest Endosc.
1995;
41
63-67
-
17
Hyun J A, Jeen Y T, Chun H J. et al .
Endoscopic resection of submucosal tumor of the esophagus: results in 62 patients.
Endoscopy.
1997;
29
165-170
-
18
Kawamoto K, Yamada Y, Furukawa N. et al .
Endoscopic submucosal tumorectomy for gastrointestinal submucosal tumors restricted to the submucosa: a new form of endoscopic minimal surgery.
Gastrointest Endosc.
1997;
46
311-317
-
19
Shikuwa S, Matsunaga K, Osabe M. et al .
Esophageal granular cell tumor treated by endoscopic mucosal resection using a ligation device.
Gastrointest Endosc.
1998;
47
529-532
-
20
Sun S, Wang M, Sun S.
Use of endoscopic ultrasound-guided injection in endoscopic resection of solid submucosal tumors.
Endoscopy.
2002;
34
82-85
-
21
Kim T I, Park Y S, Choi E H. et al .
Endoscopic resection of a large leiomyoma of the esophagus.
Gastrointest Endosc.
2004;
59
129-133
-
22
Abrassikoff A I.
Über Myome, ausgehend von der quergestreiften, willkürlichen Muskulatur.
Virchows Arch (Pathol Anat).
1926;
260
215-233
-
23
Waxman I, Saitoh Y, Raju G S. et al .
High-frequency probe EUS-assisted endoscopic mucosal resection: a therapeutic strategy for submucosal tumors of the GI-tract.
Gastrointest Endosc.
2002;
55
44-49
-
24
Chak A, Canto M, Stevens P D. et al .
Clinical applications of a new through-the-scope ultrasound probe: prospective comparison with an ultrasound endoscope.
Gastrointest Endosc.
1997;
45
291-295
-
25
Hunt G C, Smith P P, Faigel D O.
Yield of tissue sampling for submucosal lesions evaluated by EUS.
Gastrointest Endosc.
2003;
57
68-72
-
26
Catalano F, Kind R, Rodella L. et al .
Endoscopic treatment of esophageal granular cell tumors.
Endoscopy.
2002;
34
582-584
-
27
Davilla R E, Faigel D O.
GI stromal tumors.
Gastrointest Endosc.
2003;
58
80-88
-
28
Hunt G C, Rader A E, Faigel D O.
A comparison of EUS features between CD-117 positive GI stromal tumors and CD-117 negative GI spindle cell tumors.
Gastrointest Endosc.
2003;
57
469-474
T. Wehrmann, M. D.
Department of Internal Medicine I, (Gastroenterology and Interventional Endoscopy)
Klinikum Hannover-Siloah · Roesebeckstr. 15 · 30449 Hannover · Germany
Fax: +49-511-9272669 ·
eMail: twehrmann@hotmail.com