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CC BY 4.0 · Endoscopy 2024; 56(S 01): E886-E887
DOI: 10.1055/a-2421-6218
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Efficacy of endoscopic submucosal tunnel dissection in the management of a large esophageal cavernous hemangioma

Authors

  • Guang Yang

    1   Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China

  • Silin Huang

    1   Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China

  • Suhuan Liao

    1   Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China

  • Yang Lv

    2   Department of Gastroenterology, Shenzhen Hospital of Southern Medical University, Shenzhen, China (Ringgold ID: RIN559569)

  • Wei Gong

    2   Department of Gastroenterology, Shenzhen Hospital of Southern Medical University, Shenzhen, China (Ringgold ID: RIN559569)

  • Qiuping Qiu

    1   Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China

  • Nan Liu

    3   Institute of Environment and Health, South China Hospital of Shenzhen University, Shenzhen, China

Supported by: Guangdong Province Clinical Teaching Base Teaching Reform Research Project 2021JD086
Supported by: National Natural Science Foundation of China 82341019
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A 44-year-old man presented with symptoms of gastroesophageal reflux disease and dysphagia. Gastroscopy revealed a 3-cm, half-circumferential, bluish-purple esophageal mass located in the mid-esophageal region ([Fig. 1] a). Computed tomography revealed a soft tissue nodule causing significant stenosis of the esophageal lumen. Endoscopic ultrasound confirmed a well-demarcated, moderately hyperechoic submucosal lesion, characteristic of an esophageal cavernous hemangioma ([Fig. 1] b). Subsequent to a detailed consultation, endoscopic submucosal tunnel dissection (ESTD) was undertaken ([Video 1]).

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Fig. 1 Colonoscopy and endoscopic ultrasound. a Gastroscopy revealed a 3-cm, half-circumferential, bluish-purple esophageal mass located in the mid-esophageal region. b Endoscopic ultrasound confirmed a well-demarcated, moderately hyperechoic lesion within the submucosal layer.
Efficacy of endoscopic submucosal tunnel dissection for the management of a large esophageal cavernous hemangioma.Video 1

Using a hybrid knife (Erbe Elektromedizin GmbH, Tübingen, Germany), saline mixed with indigo carmine was injected 0.5 cm proximal to the lesion, followed by a 1.5-cm transverse incision to create a submucosal tunnel extending 1 cm distally ([Fig. 2] a). A significant presence of perforating vessels was observed in the submucosal layer, prompting the use of soft electrocoagulation for meticulous hemostasis ([Fig. 2] b). An additional 1.5-cm incision was made distally. Incremental dissection along both tunnel margins was performed, achieving complete en bloc resection with a 0.5-cm margin from the tumorʼs edge. Electrocoagulation was applied to exposed vessels to control bleeding, with no damage to the muscular layer ([Fig. 2] c). The procedure was completed in 30 minutes without complications, including perforation, hemorrhage, or fever. Histopathological analysis confirmed esophageal cavernous hemangioma ([Fig. 2] d). The patient was discharged on postoperative day four and remained symptom-free during 12 months of follow-up.

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Fig. 2 Endoscopic submucosal tunnel dissection. a A transverse incision was made on the oral side of the lesion to establish the tunnel entry point. b The submucosal layer revealed a notable abundance of perforating vessels. c A submucosal tunnel was meticulously fashioned, extending 1 cm distally from the incision. d Postoperative wound. e The tumor was successfully resected in its entirety. f Histopathological examination confirmed the diagnosis of esophageal cavernous hemangioma.

Esophageal cavernous hemangioma is a rare benign tumor [1], with management options for asymptomatic cases typically involving observation, whereas symptomatic cases may necessitate intervention. Treatment approaches include esophageal resection, tumor dissection, endoscopic sclerotherapy, and laser therapy [2]. Endoscopic submucosal dissection has been utilized for esophageal hemangiomas [3] [4], and our case illustrates that ESTD enhances submucosal visualization and expedites dissection. This represents the first successful en bloc resection of a symptomatic esophageal cavernous hemangioma via ESTD.

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Conflict of Interest

The authors declare that they have no conflict of interest.


Correspondence

Silin Huang, MD
Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University
No. 1 Fuxin Road, Longgang District
Shenzhen
P.R. China   

Publication History

Article published online:
16 October 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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Zoom
Fig. 1 Colonoscopy and endoscopic ultrasound. a Gastroscopy revealed a 3-cm, half-circumferential, bluish-purple esophageal mass located in the mid-esophageal region. b Endoscopic ultrasound confirmed a well-demarcated, moderately hyperechoic lesion within the submucosal layer.
Zoom
Fig. 2 Endoscopic submucosal tunnel dissection. a A transverse incision was made on the oral side of the lesion to establish the tunnel entry point. b The submucosal layer revealed a notable abundance of perforating vessels. c A submucosal tunnel was meticulously fashioned, extending 1 cm distally from the incision. d Postoperative wound. e The tumor was successfully resected in its entirety. f Histopathological examination confirmed the diagnosis of esophageal cavernous hemangioma.