Mo1287 LIGATION-ASSISTED ENDOSCOPIC MUCOSAL RESECTION FOR ESOPHAGEAL GRANULAR CELL TUMORS IS SAFE AND EFFECTIVE

Abstract

Esophageal granular cell tumors (GCTs) are usually asymptomatic and incidentally found, but have malignant potential. Given this, resection is recommended, but optimal technique remains unknown. We present the largest US series of dedicated endoscopic resection using band ligation (EMR-B) of esophageal GCTs. We performed a retrospective analysis, identifying patients diagnosed with esophageal GCTs between 2002-2019 using a prospectively-collected pathology database at our tertiary care referral center. We included those patients who underwent EMR-B of esophageal GCT using the Duette Multi-Band Mucosectomy system. Medical records were queried for patient demographics, endoscopic and pathologic findings, resection technique, adverse events, and follow up. Among 21 patients, median age was 39 years, 16 (76%) were female. Eight (38%) had preceding symptoms attributable to esophageal GCT. Upon endoscopic evaluation, 12 (57%) GCTs were found in the distal esophagus and 4 (19%) in the mid esophagus. Median lesion size was 7mm (IQR 4-8mm). The largest lesion was 12mm. Endoscopic images of esophageal GCTs are presented in Figure 1A-C. Endoscopic ultrasound was used in 15 (71%) cases. Endosonographic appearance of a granular cell tumor is presented in Figure 2. Resection was performed in all 21 patients. Submucosal lift with normal saline was used in 9 (43%). A total of 20/21 (95%) had en bloc resection upon pathologic examination. Post-resection endoscopic appearance is depicted in Figure 1D. The case without complete resection upon review was a 7mm distal esophageal GCT, resected using saline lift followed by EMR. EUS was not used. Upon pathologic evaluation, tumor was focally present at margins. Repeat endoscopy with biopsies in 6 months showed no residual tumor. No patients experienced bleeding, perforation, or stricturing. No patients have had known recurrence of esophageal GCT. EMR-B of esophageal GCTs achieves complete histopathologic resection with minimal adverse events. EMR-B is safe and effective and seems prudent compared with observation for what could be an aggressive and malignant tumor. EMR-B should be considered first-line therapy for esophageal GCT up to 12 mm in diameter.Figure 2Classic EUS appearance of a granular cell tumor (indicated by red arrow), with surrounding submucosal layer (blue dashed line) and muscularis layer (yellow arrow)View Large Image Figure ViewerDownload Hi-res image Download (PPT)