Esophageal Hemangioma Research Articles

Endoscopic Submucosal Dissection: A Safe and Effective Alternative to Surgical Intervention for Esophageal Hemangioma.

Hemangiomas represent 3% of all benign esophageal tumors. Conventional esophagectomy is the standard treatment with its invasive nature and possible surgical complications. Now, less invasive techniques are used with better results. Endoscopic submucosal dissection (ESD) is one of the novel noninvasive methods used for en bloc removal of tumors. No available data about the use of ESD in removing esophageal hemangioma. Here, we studied the validity and safety of ESD as a minimally invasive procedure to remove esophageal hemangioma. Three patients were diagnosed with esophageal hemangioma and underwent ESD with en bloc resection. Endoscopic ultrasound (EUS) was performed before ESD to better evaluate the layer of origin and vascularity and guard against perforation. Patients were followed up postintervention to document possible complications. Among the 3 studied patients, one presented with chronic abdominal pain, the second was complaining of dysphagia, and the third patient was diagnosed accidentally. Pathology reports confirmed the diagnosis of hemangiomas in all cases with no atypia and complete removal of the lesions. No complications were reported during the procedure or over the follow-up period. ESD is a proper, minimally invasive method with good en bloc resection that can be used in cases of esophageal hemangiomas.

S2907 A Rare Case of Incidental Esophageal Hemangioma in a Patient With Ulcerative Colitis Trialed on Vedolizumab

S2907 A Rare Case of Incidental Esophageal Hemangioma in a Patient With Ulcerative Colitis Trialed on Vedolizumab

Follow-up Results of Endovascular Aneurysm Repair Following Abdominal Visceral Debranching.

The aim of this study is to present a series of six cases with thoracoabdominal aneurysm treated with hybrid technique in our center. Between May 2015 and December 2018, the data of six patients with thoracoabdominal aneurysms and various comorbidities who underwent visceral debranching followed by endovascular aortic aneurysm repair were reviewed retrospectively. Patients' mean age was 65.3±19.6 years. All of them were male. Comorbidities were old age, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease, previous surgical interventions, and/or esophageal hemangioma. Except for one patient who underwent coronary artery bypass grafting (inflow was taken from ascending aorta), debranching was performed from the right iliac artery. Debranching of four visceral arteries (superior mesenteric artery, celiac trunk, and bilateral renal right arteries) was performed in three patients, of three visceral arteries (superior mesenteric artery, celiac trunk, right renal artery) was performed in one, and of two visceral arteries (superior mesenteric artery, celiac trunk) was performed in two patients. Great saphenous vein and 6-mm polytetrafluoroethylene grafts were used in one and five patients, respectively, for debranching. Endovascular aneurysm repair was performed following debranching procedures as soon as the patients were stabilized. In total, three patients died at the early, mid, and long-term follow-up due to multiorgan failure, pneumonia, and unknown reasons. Hybrid repair of thoracoabdominal aneurysms may be an alternative to fenestrated or branched endovascular stent grafts in patients with increased risk factors for open surgical thoracoabdominal aneurysm repair; however, the procedure requires experience and care.

PS01.041: REMOVAL OF ESOPHAGEAL HEMANGIOMA USING ENDOSCOPIC SUBMUCOSAL DISSECTION: A CASE REPORT AND REVIEW

Abstract Background Esophageal hemangiomas are rare, representing around 3% of all benign esophageal tumors. Esophagectomy or tumor enucleation has been performed to treat esophageal hemangiomas, but recently the use of endoscopic therapy, such as endoscopic mucosal resection or endoscopic injection sclerotherapy, is increasing. We describe removal of a hemangioma using endoscopic submucosal dissection. Methods A 59-year-old woman underwent endoscopic examination after an esophageal lesion was found during a general health examination. Endoscopy identified a broad-based, elevated, dark purple lesion located 17 cm distal from the incisor teeth. It measured approximately 25 mm and was rounded and soft.Endoscopic ultrasonography using a 20-MHz catheter probe and the water filling method identified a tumor 25 mm in diameter located in the mucosal and submucosal layers. The border was unclear, but the bottom of the tumor was demarcated from the adjacent normal muscle layer. Compared with the adjacent muscle layer, the tumor was hyperechoic. On the basis of these endoscopic findings, the lesion was diagnosed as a hemangioma. Because the tumor was broad-based and relatively large, we thought that polypectomy or EMR should be avoided to prevent incomplete resection and postoperative hemorrhage from the residual stump. We therefore decided that ESD was the best treatment modality for this lesion. Results Approximately 2 mL of the solution was injected into the submucosal layer at intervals, which was repeated until the mucosa became elevated. After lifting the lesion, the mucosa including the tumor was gently cut with the Flush knife using the Endocut mode. The submucosal layer was highly fibrous, so lifting the lesion was somewhat difficult. The histopathological findings showed formation of a vascular lumen with irregular dilatation just below the lamina muscularis mucosa, suggesting a cavernous hemangioma. The patient was discharged 5 days after surgery without complications. Conclusion Until quite recently, large or broad-based esophageal hemangiomas had been treated by esophagectomy or sclerotherapy. Esophagectomy is associated with a high mortality rate [19], and endoscopic sclerotherapy may cause hemorrhage upon puncture, side effects due to the infused agents, and other complications. Endoscopic resection is less invasive than sclerotherapy, and further advances in endoscopic treatment and instruments may reduce the risk of several complications. ESD has being established as a safer, less invasive therapy than esophagectomy, it is perhaps the best therapeutic option for treating large or broad-based submucosal esophageal hemangiomas. Disclosure All authors have declared no conflicts of interest.

An Uncommon Mass of the Esophagus: Esophageal Hemangioma

A 73-year-old woman complaining of retrosternal pain and swallow discomfort over the past 1 month was admitted to our hospital. She denied any dysphonia, regurgitation or weight loss. Physical examination was unremarkable. The hematological and biochemical profiles were normal. Barium meal studies revealed a smooth oval-shape mass with broad pedicle in the posterior wall of the upper esophagus (Figur 1). The patient refused to endoscopic investigation because of irregular heart rhythms. Further chest CT scan revealed a soft tissue mass with punctuate calcification and narrowing of the lumen to around 40% of the original size. The lesion showed moderately inhomogeneous enhancement after contrast injection (Figure 2 & 3). There was no lymphatic node adenopathy in the mediastinum. Based on her symptoms and related radiological findings, the patient was firstly suspected with esophageal hemangioma and underwent thoracoscopic enucleating. Intraoperative photography showed deep-red lesion with smooth surface (Figure 4) and the mass was completely resected under the thoracoscopy. Histopathological findings were consistent with esophageal haemangioma (Figure 5). Post-operative course was uneventful and the patient’s symptom of retrosternal chest pain was completely resolved after surgery. She remained asymptomatic at 2-year follow-up.

Patient with Huge Upper Esophageal Hemangioma

ABSTRACTBackgroundCervical esophageal hemangioma is a rare benign tumor. Symptoms may include hematemesis, dyspnea, cough, dysphagia, and chest pain.ObjectivesTo describe a case of a large esophageal hemangioma in order to raise awareness of the condition and highlight the use of a cooperative endoscopic treatment approach by a gastroenterologist and otolaryngologist with excellent results. The literature on large esophageal hemangioma is reviewed.Materials and methodsAn otherwise healthy male presented with a huge hemangioma of the upper esophagus. Imaging showed the mass hanging on a narrow stalk attached to the posterior wall of the cricopharyngeus muscle, filling the lumen of the cervical and mediastinal esophagus. Resection was accomplished with a combination of flexible gastroscopy and microscope-assisted rigid direct laryngoscopy.ResultsPathologic evaluation showed a polypoid mass covered with squamous epithelium, with multiple engorged blood vessels. Some of the vessels were wide, surrounded by a thin wall, and others were narrow with a thick wall. The histology was compatible with arteriovenous hemangioma. There was no evidence of malignancy. At the 7-month postoperative follow-up, the patient appeared well, with no dyspnea or dysphagia. Our literature search yielded only two published cases of a huge hemangioma of the upper esophagus, which were treated by open resection. Ours is the first report of the use of endoscopic excision.ConclusionLarge esophageal hemangioma should be part of the differential diagnosis of dyspnea, dysphagia, persistent cough, or chest pain. A combined approach by a gastroenterologist and otolaryngologist, working cooperatively, can facilitate the correct diagnosis and provide optimum treatment.How to cite this articleAlkan U, Geller A, Shvero J. Patient with Huge Upper Esophageal Hemangioma. Int J Otorhinolaryngol Clin 2017;9(1):25-27.

A case of esophageal hemangioma treated with endoscopic injection sclerotherapy

A case of esophageal hemangioma treated with endoscopic injection sclerotherapy

A Case of Esophageal Hemangioma Successfully Treated by Endoscopic Injection Sclerotherapy

A 44-year-old man was referred to our hospital for therapy for an esophageal hemangioma that had increased remarkably in size over three years of endoscopic follow-up.Although the patient had no history of dysphagia or hematemesis, prophylactic removal of the tumor was planned to prevent hemorrhage. The hemangioma was treated successfully by two rounds of endoscopic injection sclerotherapy(EIS)using 5% monoethanolamine oleate.Only mild chest pain was noted during therapy. Esophageal hemangioma is a rare disease that may cause bleeding or difficulty eating.Surgical resection, endoscopic mucosal resection,endoscopic submucosal dissection,and laser therapy have all been reported as treatment measures for these lesions.We opted for EIS in the present case because of its low invasiveness and ability to treat lesions protruding from the esophageal wall.Blood flow volume and the precise location of the tumor in the esophageal wall should be evaluated by imaging examinations when deciding on the treatment for esophageal hemangioma.Shinshu Med J 64 : 75―78, 2016 (Received for publication November 18,2015;accepted in revised form December 8,2015)

Esophageal hemangioma and hilar cholangiocarcinoma: a espectrum of rare findings in one single patient

Esophageal hemangioma and hilar cholangiocarcinoma: a espectrum of rare findings in one single patient

Clinical characteristics and treatment of esophageal hemangioma: Analysis of 48 cases

Clinical characteristics and treatment of esophageal hemangioma: Analysis of 48 cases

Discoloration of the Esophagus

Question: A 74-year-old white woman with a past medical history of dyslipidemia, irritable bowel syndrome, and gastroesophageal reflux disease presented with abdominal bloating and persistent cough. She had no history of heartburn, dysphagia, or odynophagia. An upper endoscopy was performed. On endoscopy, the esophageal mucosa appeared bulbous with a blue tint. The lesion was 6 cm in size between 18 and 24 cm from the incisors (Figure A, B). The rest of the examination was normal. As part of her evaluation, computed tomography of the neck, chest, and abdomen was performed (Figure C). What is this lesion? Look on page 1501 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. This is a large cavernous esophageal hemangioma. Hemangioma is a rare tumor of the esophagus, representing approximately 3% of benign tumors of the esophagus. Incidence in the population at large was 0.04% in an autopsy study.1Moersch H.J. Harrington S.W. Benign tumor of the esophagus.Ann Otol Rhinol Laryngol. 1944; 53: 800Google Scholar, 2Raza W. Nasir H. Ilahi F. et al.Esophageal haemangioma: a case report and review of literature.J Pak Med Assoc. 2010; 60: 310-311PubMed Google Scholar The patient had a history of irritable bowel syndrome and presented with symptoms of abdominal bloating and cough. Endoscopy was performed to evaluate her symptoms. The patient also had a prior history of gastroesophageal reflux disease and an esophagogastroduodenoscopy had been performed in 2008, which showed a smaller area of blue discoloration in the same location. Computed tomography of the chest was performed with 150 ccs Omnipaque 300 IV contrast. The lungs were clear. There was a low-density, rounded mass measuring approximately 3 × 2 × 3.5 cm adjacent to the esophagus. This was at the level of the aortic arch. Several small calcifications within this structure were consistent with a hemangioma. The mass was relatively well demarcated. No lymphadenopathy was seen. No other masses were identified. No other esophageal lesions were suspected. Esophageal hemangioma is typically asymptomatic, but because of the size of this lesion the patient was sent to a university hospital for further evaluation. The patient and thoracic surgeon elected to follow a conservative treatment plan because her symptoms had resolved. When symptomatic the most common course of treatment is operative resection, but endoscopic resections have also been successful.3Sogabe M. Taniki T. Fukui Y. et al.A patient with esophageal hemangioma treated by endoscopic mucosal resection: a case report and review of the literature.J Med Invest. 2006; 53: 177Crossref PubMed Scopus (20) Google Scholar

Indications of endoscopic submucosal dissection for symptomatic benign gastrointestinal subepithelial or carcinoid tumors originating in the submucosa

Endoscopic submucosal dissection (ESD) for upper gastrointestinal (GI) subepithelial tumors (SETs) originating in the muscularis propria (MP) layer is associated with numerous issues regarding secure closure and measures against accidental perforation. However, symptomatic benign GI SETs or carcinoid tumors originating in the submucosa (SM) may be safely resected en-bloc using ESD. In this study, the feasibility and safety of ESD as a novel method for endoscopic resection for such GI SETs revealed on endoscopic ultrasonography (EUS) was investigated. A total of 12 consecutive cases of patients with symptomatic benign SETs (n=3; 1 esophageal hemangioma and 2 gastric lipomas) or small carcinoid tumors (n=9; <10 mm, with an extremely low risk of metastasis) originating in the SM as determined on EUS, between March, 2009 and April, 2013, were retrospectively reviewed. The lesions were resected by ESD after confirming that the tumors originated from the SM. The complication rate following en-bloc resection was also determined. En-bloc resection was achieved in all 12 cases, the mean procedure time was 45 min (range, 20-120 min) and no complications occurred intra- or postoperatively. There was no tumor recurrence or disease-related mortality reported during the follow-up period (median follow-up time, 13.4 months). Histopathological curative resection was achieved with ESD without complications in all 9 cases with carcinoid tumors. Therefore, if EUS reveals a SET originating in the SM without infiltration of the MP and resection is indicated due to the presence of abdominal symptoms, ESD may be a feasible option for diagnostic treatment with minimal invasiveness. However, larger-scale prospective studies are required to establish the feasibility and safety of this procedure.

Removal of broad-based esophageal hemangioma using endoscopic submucosal dissection

Esophageal hemangiomas are rare, representing around 3 % of all benign esophageal tumors. Esophagectomy or tumor enucleation has been performed to treat esophageal hemangiomas, but recently the use of endoscopic therapy, such as endoscopic mucosal resection or endoscopic injection sclerotherapy, is increasing. We describe removal of a hemangioma using endoscopic submucosal dissection. We also briefly discuss the literature concerning clinicopathologic aspects and management of esophageal hemangioma.

Successful en bloc resection of an esophageal hemangioma by endoscopic submucosal dissection

Successful en bloc resection of an esophageal hemangioma by endoscopic submucosal dissection

Cervical Esophageal Hemangioma Combined with Thyroid Cancer

Hemangiomas that arise in cervical esophagus are extremely rare, representing 3.3% of all benign esophageal tumors. Although endoscopic mucosal resection (EMR) and potassium titanyl phosphate/yttrium aluminum garnet (KTP/YAG) laser therapy have been used with success for small tumors, the safety and efficacy in the case of large tumors remains uncertain. We report the successful resection of cervical esophageal hemangioma through a cervical esophagotomy in a patient with thyroid cancer who needed a cervical collar incision.

Symptomatic esophageal hemangioma removed by EMR

Symptomatic esophageal hemangioma removed by EMR

Management of postcricoid and upper esophageal hemangioma

To discuss management of postcricoid and upper esophageal hemangiomas in infants. Four children presenting with progressive feeding and/or respiratory disturbance underwent endoscopy including systematic esophagoscopy revealing the hemangioma of the postcricoid area and extending to the lumen of the upper esophagus. In the three children with severe disturbance, systemic steroids were insufficient and open surgical excision brought the hemangioma under control. No significant stenosis occurred despite prolonged progressive oral feeding up to 1 month after surgery. The fourth child whose disturbance was moderate, was managed by intralesional steroids. Various solutions have been proposed for the treatment, i.e. conservative approach or partial or complete destruction or excision, management of postcricoid hemangioma by intralesional steroids or by open surgical excision. Indications will require greater series.

A patient with esophageal hemangioma treated by endoscopic mucosal resection: a case report and review of the literature

In a 58-year-old male, upper digestive endoscopy revealed a protruding lesion in the esophagus on a medical examination. The patient was referred to the Department of Surgery in our hospital to undergo surgery. On the initial consultation, upper digestive endoscopy showed a smooth, soft, black purple, type II protruding lesion measuring approximately 25 mm at 35 cm apart from the incisor. For diagnostic treatment and patient's request, endoscopic mucosal resection (EMR) was performed. The resected specimen measured 25 mm x 25 mm. The histological findings suggested cavernous hemangioma. To treat esophageal hemangioma, esohagectomy, tumor enucleation, or sclerotherapy has been performed. However, recently, thorough preoperative examination, such as endoscopic ultrasonography (EUS), has facilitated endoscopic resection, such as EMR.

Minimal access thoracic surgery for esophageal hemangioma

Esophageal hemangioma is a rare tumor. This report describes the case of a 69-year-old woman with an esophageal tumor at the middle portion of the esophagus. The patient was successfully treated with minimal access thoracic surgery, and at the 6 month follow-up, the patient was free of any symptoms or recurrence.

Endoscopic sclerotherapy for esophageal hemangioma

Esophageal hemangioma is extremely rare among the benign tumors, and surgical 1 Taylor FH Fowler FC Betsill Jr, WL Marroum MC. Hemangioma of the esophagus. Ann Thorac Surg. 1996; 61: 726-728 Abstract Full Text PDF PubMed Scopus (7) Google Scholar , 2 Hanel K Talley NA Hunt DR. Hemangioma of the esophagus: an unusual cause of upper gastrointestinal bleeding. Dig Dis Sci. 1981; 26: 257-263 Crossref PubMed Scopus (28) Google Scholar , 3 White IL Dunkelman D. Obstructive cervical esophageal hemangioma. Ear Nose Throat J. 1981; 60: 324-327 PubMed Google Scholar or endoscopic resections 4 Cantero D Yoshida T Ito T Suzumi M Tada M Okita K. Esophageal hemangioma: endoscopic diagnosis and treatment. Endoscopy. 1994; 26: 250-253 Crossref PubMed Scopus (24) Google Scholar , 5 Yoshikane H Suzuki T Yoshioka N Ogawa Y Ochi T Hasegawa N. Hemangioma of the esophagus: endosonographic imaging and endoscopic resection. Endoscopy. 1995; 27: 267-269 Crossref PubMed Scopus (23) Google Scholar have mainly been reported, with surgical resection being generally accepted as the standard treatment. More recently, endoscopic resection has been successful, but it has been limited to small or pedunculated tumors that have an associated risk of hemorrhage.