Endoscopic Mucosal Resection for Esophageal Granular Cell Tumors

Abstract

Purpose: Granular cell tumors (GCTs) are rare subepithelial lesions that may arise in the esophagus. Endoscopic mucosal resection (EMR) is used for the diagnosis, staging, and eradication of superficial esophageal neoplasms. EMR has been suggested as a treatment option for GCTs, but data is limited. Methods: A prospectively-collected pathology database was used to identify patients with esophageal GCT over the past 10 years at a university medical center. Information regarding demographic data, procedural findings, technical details of resection and adverse events was collected. Results: Fifteen patients (11 female, 4 male) with a mean age of 40 years (range, 21-64 years) were diagnosed with esophageal GCT. The majority of lesions (93%) were located in the distal esophagus. EMR was not performed in 4 patients (2 with muscularis propria involvement by EUS, 1 due to physician/patient decision, 1 GCT could not be re-identified). EMR was attempted by an experienced therapeutic endoscopist in the remaining 11 patients (Table 1). En bloc resection was achieved in 10/11 patients (91%) requiring only one session. Ligation-assisted EMR was performed in 8 patients (73%) and cap-assisted EMR was performed in the remaining 3 patients. A submucosal lift with normal saline was used in 7 cases (64%). Multiple esophageal GCTs were noted in two patients (case #5 had 4 lesions & case #8 had 2 lesions), all of which were completely excised. One lesion demonstrated a satisfactory submucosal lift; however, it was too large to be suctioned into a cap and further attempts to salvage resection failed to fully engage the lesion within the snare. This same patient later underwent operative resection of a gastric submucosal lesion and was diagnosed with a gastric GCT. There were no adverse events associated with ligation-assisted EMR. Two patients (18%) experienced acute bleeding after cap-assisted EMR. The patient in case #9 was treated with 4 cc of epinephrine with hemostasis achieved. The patient in case #10 had an ulcerated lesion that was treated with 8 cc of epinephrine after resection. This patient and was admitted to the hospital for overnight observation without further intervention. There were no cases of perforation.Table: [1871]Conclusion: Esophageal GCTs occur more commonly in the distal esophagus and appear to have a female predilection. EMR has a high rate of complete en bloc resection for esophageal GCTs. Lesion size is a limitation to EMR. While ligation-assisted EMR may reduce the risk of immediate bleeding, endoscopists performing EMR of esophageal GCTs should be prepared to manage the complications of bleeding. Disclosure: Dr. Chandrasekhara - None. Dr. Wilson - None. Dr. Ginsberg - None. Dr. Kochman - Spouse works for Merck.