Endoscopic ultrasonography in diagnosis and minimally invasive treatment of esophageal leiomyoma

Abstract

Objective To evaluate the diagnostic value of endoscopic ultrasonography (EUS) and endoscopic therapies in esophageal leiomyoma under the guidance of EUS, and to assess the clinical efficacy and safety of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for esophageal leiomyoma.Methods A total of 40 patients with submucosal tumors (SMT) of the esophagus diagnosed by endoscopy were examined by EUS.Of these patients, esophageal ieiomyoma was found deriving from muscularis mucosa in 30 and from proper muscle layer in 4.All muscularis mucosa-derived lesions were completely removed with EMR or ESD depending on tumor size, while the proper muscle layer- derived lesions did not receive endoscopic surgery due to a higher risk of esophageal perforation.Results The resected SMT sized 0.4-2.5 cm in diameter (mediam: 1.45 cm).Among the 40 lesions, 24 were successfully resected by EMR and 6 with diameter over 1.5 cm were resected by ESD.The mediam ESD procedure time was 30 rain (range 15 to 45 min).Two patients had massive hemorrhage during ESD, which could be controlled under gastroscopic spray of hemostatie agents, electric cautery, argon plasma coaqulation and titanic clip placement.None of the patients had delayed bleeding or perforation after ESD.Histological evaluation showed that the tunica of the tumors was intact, and beth the lateral and basal margins of the specimens were free of tumor cells.Follow-up at 1.5 and 6 months after ESD healing of artificial ulcer was confirmed with no residue or recurrence.Conclusions Esophageal leiomyoma can be definitely diagnosed by EUS and subjected to EUS-guided treatment.Most of esophageal leiomyoma may be resected simply and safely by EMR.For larger lesions that may be difficult to resect completely with EMR, ESD can be a safe and effective substitute, which yielded not only complete removal, but also complete information for pathological study. Key words: Endosonography; Leiomyoma; Esophagoscopy; Endoscopic mucnsal resection; Endoscopic submucosal dissection