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Submucosal double-tunnel endoscopic resection of the esophageal leiomyoma
VideoGIE
Submucosal double-tunnel endoscopic resection of the esophageal leiomyoma
Figure 1. Submucosal tunnel endoscopic resection of the esophageal leiomyoma. A, EUS: the tumor, 21 mm in size, originating from the muscle layer, located in close proximity to the aorta, suggestive for GIST or leiomyoma. B, Submucosal tumor disappearing into the posterior mediastinum. C, The second (transmuscular) tunnel leading into the posterior mediastinum, clearly visible after complete removal of the tumor. D, Immunohistochemistry: CD 117 is absent.
A 30-mm submucosal tumor (SMT) of the distal esophagus was found on EGD in a 54-year-old woman a year before admission. She had complained of periodic dysphagia and had a progressive fear of cancer. EUS revealed the SMT, originating from the muscularis propria, with hypoechoic echo-structure, anechoic, and hyperechoic areas. Submucosal tunnel endoscopic resection was performed (Video 1, available online at www.giejournal.org). The longitudinal mucosal incision was made 5 cm orally to the tumor. A submucosal tunnel was created using the spray coagulation mode and extended beyond the SMT to secure enough working space. The tumor had an egg-shaped appearance with an actual size of 40 21 mm, twice as much as EUS data had suggested and extraluminal growth to the posterior mediastinum. One fourth of the SMT was dissected through the submucosal tunThis video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store. 1278 GASTROINTESTINAL ENDOSCOPY Volume 83, No. 6 : 2016
nel; the other three quarters were dissected through the 2-cm window in the muscularis propria and adventitia, thus creating a second tunnel into the mediastinum (Fig. 1A-D). Finally, the tumor was resected with a polypectomy snare. The mucosal entry was closed with 8 clips. The postoperative period was uneventful. Proton pump inhibitors and antibiotics were routinely used. Histopathology showedexpression of CD-117, DOG-1, and CD-34 was absent; active expression of actin, nonuniformly, vimentin; Ki 67 less than 1%; no mitosis leiomyoma. EGD 5 months later revealed no residual or recurrent tumor with only a mild scar without distortion. DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Evgeny D. Fedorov, PhD, MD, Sergey G. Schapovalyanz, PhD, MD, Roman V. Plakhov, PhD, MD, Stanislav A. Budzinsky, PhD, MD, Evgeny V. Gorbachev, MD, Moscow University Hospital N31, Pirogov Russia National State Medical University, Moscow, Russian Federation http://dx.doi.org/10.1016/j.gie.2015.12.018
www.giejournal.org
Submucosal double-tunnel endoscopic resection of the esophageal leiomyoma
Figure 1. Submucosal tunnel endoscopic resection of the esophageal leiomyoma. A, EUS: the tumor, 21 mm in size, originating from the muscle layer, located in close proximity to the aorta, suggestive for GIST or leiomyoma. B, Submucosal tumor disappearing into the posterior mediastinum. C, The second (transmuscular) tunnel leading into the posterior mediastinum, clearly visible after complete removal of the tumor. D, Immunohistochemistry: CD 117 is absent.
A 30-mm submucosal tumor (SMT) of the distal esophagus was found on EGD in a 54-year-old woman a year before admission. She had complained of periodic dysphagia and had a progressive fear of cancer. EUS revealed the SMT, originating from the muscularis propria, with hypoechoic echo-structure, anechoic, and hyperechoic areas. Submucosal tunnel endoscopic resection was performed (Video 1, available online at www.giejournal.org). The longitudinal mucosal incision was made 5 cm orally to the tumor. A submucosal tunnel was created using the spray coagulation mode and extended beyond the SMT to secure enough working space. The tumor had an egg-shaped appearance with an actual size of 40 21 mm, twice as much as EUS data had suggested and extraluminal growth to the posterior mediastinum. One fourth of the SMT was dissected through the submucosal tunThis video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store. 1278 GASTROINTESTINAL ENDOSCOPY Volume 83, No. 6 : 2016
nel; the other three quarters were dissected through the 2-cm window in the muscularis propria and adventitia, thus creating a second tunnel into the mediastinum (Fig. 1A-D). Finally, the tumor was resected with a polypectomy snare. The mucosal entry was closed with 8 clips. The postoperative period was uneventful. Proton pump inhibitors and antibiotics were routinely used. Histopathology showedexpression of CD-117, DOG-1, and CD-34 was absent; active expression of actin, nonuniformly, vimentin; Ki 67 less than 1%; no mitosis leiomyoma. EGD 5 months later revealed no residual or recurrent tumor with only a mild scar without distortion. DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Evgeny D. Fedorov, PhD, MD, Sergey G. Schapovalyanz, PhD, MD, Roman V. Plakhov, PhD, MD, Stanislav A. Budzinsky, PhD, MD, Evgeny V. Gorbachev, MD, Moscow University Hospital N31, Pirogov Russia National State Medical University, Moscow, Russian Federation http://dx.doi.org/10.1016/j.gie.2015.12.018
www.giejournal.org