VIDEOGIE Todd H. Baron, MD, G. S. Raju, MD, Editors for VideoGIE
Submucosal tunneling endoscopic resection of a giant esophageal leiomyoma
Figure 1. A, The lesion (arrow) can be seen adjacent to the descending aorta. B, A hypoechoic mass originating from the muscularis propria layer of the esophagus on radial EUS. C, The lesion within the tunnel after dissection off the muscularis propria. D, A large empty tunnel after retrieval of the lesion.
Submucosal tunneling endoscopic resection (STER) for removal of upper GI tumors arising from the muscularis propria (MP) has been demonstrated to be effective and safe. In this video, we demonstrate the feasibility of STER for a giant, symptomatic esophageal leiomyoma and the closure of a large mucosal entry. A 53-year-old woman was seen with a 2-month history of progressive dysphagia and chest pain. A chest CT scan revealed a 6 2.8 2.2-cm esophageal mass adjacent to the descending aorta and azygos vein (Fig. 1; Video 1, available online at www. giejournal.org). EUS-guided core biopsy confirmed the diagnosis of leiomyoma. A submucosal tunnel was created and extended distal to the lesion. The leiomyoma was then carefully dissected off the MP en bloc. The lesion was extracted from the tunnel only after extension of the mucosal entry and subsequent fragmentation. Closure of the large mucosal entry was not achieved despite using an over-the-scope clip. Therefore, a 23 105-mm fully covered self-expandable metal esophageal stent was placed. Repeat endoscopy and removal of the stent 10 days after the procedure revealed closure of the www.giejournal.org
mucosal entry. We demonstrate that STER is feasible and safe even in the setting of a giant lesion and is a suitable alternative to surgery. DISCLOSURE The following author disclosed a financial relationship relevant to this article: Dr Khashab is a consultant for Boston Scientific and Olympus America and has received research support from Cook Medical. Dr Saxena has received consulting fees from Boston Scientific and research support from Cook Medical. All other authors disclosed no financial relationships relevant to this article. Vivek Kumbhari, MD, Payal Saxena, MD, Alba Azola, MD, Ahmed A. Messallam, MD, Mohamad H. El Zein, MD, Mouen A. Khashab, MD, Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA http://dx.doi.org/10.1016/j.gie.2014.04.010
Volume
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No.
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: 2014 GASTROINTESTINAL ENDOSCOPY 1
Submucosal tunneling endoscopic resection of a giant esophageal leiomyoma
Figure 1. A, The lesion (arrow) can be seen adjacent to the descending aorta. B, A hypoechoic mass originating from the muscularis propria layer of the esophagus on radial EUS. C, The lesion within the tunnel after dissection off the muscularis propria. D, A large empty tunnel after retrieval of the lesion.
Submucosal tunneling endoscopic resection (STER) for removal of upper GI tumors arising from the muscularis propria (MP) has been demonstrated to be effective and safe. In this video, we demonstrate the feasibility of STER for a giant, symptomatic esophageal leiomyoma and the closure of a large mucosal entry. A 53-year-old woman was seen with a 2-month history of progressive dysphagia and chest pain. A chest CT scan revealed a 6 2.8 2.2-cm esophageal mass adjacent to the descending aorta and azygos vein (Fig. 1; Video 1, available online at www. giejournal.org). EUS-guided core biopsy confirmed the diagnosis of leiomyoma. A submucosal tunnel was created and extended distal to the lesion. The leiomyoma was then carefully dissected off the MP en bloc. The lesion was extracted from the tunnel only after extension of the mucosal entry and subsequent fragmentation. Closure of the large mucosal entry was not achieved despite using an over-the-scope clip. Therefore, a 23 105-mm fully covered self-expandable metal esophageal stent was placed. Repeat endoscopy and removal of the stent 10 days after the procedure revealed closure of the www.giejournal.org
mucosal entry. We demonstrate that STER is feasible and safe even in the setting of a giant lesion and is a suitable alternative to surgery. DISCLOSURE The following author disclosed a financial relationship relevant to this article: Dr Khashab is a consultant for Boston Scientific and Olympus America and has received research support from Cook Medical. Dr Saxena has received consulting fees from Boston Scientific and research support from Cook Medical. All other authors disclosed no financial relationships relevant to this article. Vivek Kumbhari, MD, Payal Saxena, MD, Alba Azola, MD, Ahmed A. Messallam, MD, Mohamad H. El Zein, MD, Mouen A. Khashab, MD, Department of Medicine and Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA http://dx.doi.org/10.1016/j.gie.2014.04.010
Volume
-,
No.
-
: 2014 GASTROINTESTINAL ENDOSCOPY 1
