Endoscopic full-thickness resection is a safe and effective method for the treatment of sigmoid schwannomas

We report the case of a 49-year-old man with a distal sigmoid schwannoma that was accidentally found during a screening colonoscopy. The patient was referred to our Center for further evaluation. Endoscopic ultrasound (EUS) confirmed the presence of a sigmoid lesion showing a well-circumscribed hyperenhancing mass of 10 mm in diameter, compatible with a gastrointestinal stromal tumor. We decided to perform a full-thickness resection (FTR) of the lesion ([Video 1]). Chromoendoscopy showed the submucosal lesion located in the distal sigmoid colon, near to a previously placed endoscopic tattoo ([Fig. 1 a]). First, the edges of the lesion were marked with the FTR device (FTRD) Marking Probe (Olympus) ([Fig. 1 b]), the lesion was pull into the FTRD system set (Ovesco Endoscopy) ([Fig. 1 c]) and then removed, with placement of an over-the-scope (OTS) clip ([Fig. 1 d]). The resected lesion was recovered outside and placed on a cork for histological analysis ([Fig. 2]). No periprocedural complications were observed. Later the same day, after an adequate period of observation, the patient was discharged from our hospital in good general condition. At 3- and 6-month follow-up, rectosigmoidoscopy showed a flat and regular scar, with no macroscopic signs of residual tissue or recurrence, confirming the complete resection of the lesion.

Video 1 Full-thickness resection of a distal sigmoid colon schwannoma.

Fig. 1 Endoscopic images showing: a schwannoma of the sigmoid colon; b edges of the lesion marked with the full-thickness resection device (FTRD) Marking Probe (Olympus); c lesion pulled into the FTRD System Set (Ovesco Endoscopy); d over-the-scope (OTS) clip placed after resection of the schwannoma.

Fig. 2 Macroscopic appearance of the resected schwannoma pinned onto cork prior to histological analysis.

Schwannomas are benign, encapsulated, slow-growing, and usually solitary tumors originating from Schwann cells of the peripheral nerve sheath [1]. In the literature, only two papers have been published on the treatment of schwannomas with FTR [2] [3]. Our experience confirms that FTR, performed by experienced endoscopists, represents a safe and curative technique for the treatment of this rare neoplasm of the gastrointestinal tract. In the future, prospective studies with a larger number of patients are needed for further validation of this technique in the treatment of schwannomas.

Endoscopy_UCTN_Code_CCL_1AD_2AC

Competing interests

The authors declare that they have no conflict of interest.

• References

• 1 Bohlok A, El Khoury M, Bormans A. et al. Schwannoma of the colon and rectum: a systematic literature review. World J Surg Onc 2018; 16: 125
• 2 Ferreira Cardoso M, Cai M, Xu M. Endoscopic full‐thickness resection of a colonic schwannoma. Dig Endosc 2019; 31: e52-e53
• 3 Ming-yan C, Yun-shi Z, Ping-hong Z. et al. Feasibility of endoscopic full-thickness resection in the treatment of colorectal submucosal tumors. Zhonghua Wei Chang Wai Ke Za Zhi 2012; 15: 679-681

Publication History

Article published online:
02 December 2022