Abstract
Background and Study Aims: Although most submucosal tumors of the esophagus are benign, reliable exclusion of
leiomyosarcoma requires histological analysis. However, this is rarely possible with
an endoscopic forceps biopsy. In an attempt to establish the diagnosis, and as an
alternative to surgery, we present here our experience with the endoscopic removal
of submucosal tumors of the esophagus using two different techniques.
Patients and Methods: Sixty-two patients (38 men, 24 women, mean age 47) with submucosal tumors of the
esophagus were treated endoscopically. If the tumor was less than 2 cm in diameter,
polypoid, or showed a round protrusion with at least moderate elevation at endoscopy,
a conventional snare polypectomy was performed. If the tumor was larger than 2 cm
in diameter or only mildly elevated, the technique of modified endoscopic incisional
enucleation was carried out, consisting of complete stripping of the overlying tissue
followed by tumor enucleation using an electrocautery snare and a coagulation electrode.
Results: Based on these criteria, 36 patients underwent conventional snare polypectomy, and
25 received endoscopic incisional enucleation; complete resection of the tumor was
possible in these 61 cases. In one patient, only partial removal was possible, due
to firm and wide adhesions to the surrounding tissue. The tumor diameters ranged from
0.6 cm to 7.5 cm, with a mean value of 1.9 cm; 14 tumors measured more than 3 cm.
At histopathology, the resected specimens were found to be 56 leiomyomas, four granular
cell tumors, one neurogenic tumor, and one cyst. No serious complications such as
perforation or massive bleeding occurred, and oozing bleeding, which was encountered
in three patients, was easily managed by endoscopic electrocoagulation. During the
follow-up period (mean 38.4 months, range 3-107 months) no recurrence was observed
in any of the 61 patients who received complete resections.
Conclusion: This method of endoscopic removal of submucosal tumors of the esophagus appears to
be safe and effective in experienced hands. It allows complete histopathological workup,
and at the same time complete removal of the tumor. The method can be considered as
an alternative to surgery in symptomatic cases.
