TECHNIQUE AND EFFICACY OF ENDOSCOPIC ENUCLEATION FOR THE ESOPHAGEAL SUBMUCOSAL TUMOR

Abstract

Leiomyoma is a relatively common submucosal tumor in esophagus. The technique and efficacy of a novel method for the resection of these tumors, endoscopic enucleation using the jet of saline, was evaluated. Endoscopic ultrasonography (EUS) was always performed before the resection. If the high echoic layer was verified the outside of the tumor in the esophageal submucosal layer, this esophageal endoscopic enucleation was selected, but if the tumor was attached to the muscularis propria of the esophagus, thoracoscopic enucleation was recommended. The method of esophageal endoscopic enucleation was as following. The mucosal layer on the submucosal tumor was incised by a needle knife, the tumor was directly grasped with endoscopic forceps and dissected from the esophageal submucosal layer with the jet of saline by a hydro-dissection pump or a electric pressure pump. A week after resection, the lesions were observed endoscopically. Esophageal endoscopic enucleation was selected in 27 cases of leiomyoma arising in the submucosal layer as determined by EUS and successful in 25 cases. The size of the specimens was 1.8 cm (0.8-4.5 cm), and all of the resulting ulcerations at the site of resection healed without the fur within 1 week. The pneumomediastinum was occurred in only 1 case, and the complication rate resulting from this procedure was acceptable. There has been no local recurrence in completely sloughed cases. Conclusions : Our technique of endoscopic enucleation using the jet of saline appears to be a safe and useful procedure for esophageal submucosal leiomyomas.