Download PDF
Open Access
CC BY 4.0 · Endoscopy 2025; 57(S 01): E688-E689
DOI: 10.1055/a-2615-6193
E-Videos

Application of an all-in-one snare probe in submucosal tunneling endoscopic resection for an esophageal leiomyoma: the first clinical experience

Authors

  • Jiashaer Bahetinuer  ‡

    1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital Fudan University, Shanghai, China (Ringgold ID: RIN92323)

  • Baohui Song‡

    1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital Fudan University, Shanghai, China (Ringgold ID: RIN92323)

  • Xucheng Huo

    1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital Fudan University, Shanghai, China (Ringgold ID: RIN92323)

  • Ping-Hong Zhou

    1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital Fudan University, Shanghai, China (Ringgold ID: RIN92323)

  • Mei Liu

    2   Department of Gastroenterology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China (Ringgold ID: RIN66375)

  • Ming-Yan Cai

    1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital Fudan University, Shanghai, China (Ringgold ID: RIN92323)

Supported by: Shanghai Municipal Health Commission Health Industry Clinical Research Project 202340178
Supported by: 2023 Special Clinical Research Fund of Zhongshan Hospital Affiliated to Fudan University ZSLCYJ202350
Further Information
Also available at
 
 PDF Download Permissions and Reprints

Submucosal tunneling endoscopic resection (STER) establishes a tunnel between the submucosa and muscularis propria proximally to the lesion for en bloc resection, preserving mucosal integrity at the lesion site [1]. Studies have confirmed the efficacy and safety of STER for esophageal leiomyomas [2]. Traditional STER requires multiple instrument exchanges, whereas our all-in-one (AIO, Leomedical, Changzhou, China) device integrates electrosurgical dissection, intraoperative supplementary injection, and snaring, reducing the need for intraprocedural instrument changes ([Fig. 1]). We herein present a case of AIO-assisted STER for resection of an esophageal leiomyoma.

Zoom
Fig. 1 The all-in-one device integrates electrosurgical dissection, intraoperative supplementary injection, and snaring, reducing the need for intraprocedural instrument changes. ESD, endoscopic submucosal dissection.

A 71-year-old woman presenting with retrosternal discomfort for 1 month underwent gastroscopy, which revealed an esophageal submucosal tumor located 21 cm from the incisors ([Fig. 2]). Further endoscopic ultrasonography revealed a 25 × 20 mm hypoechoic mass originating from the muscularis propria layer. The patient subsequently underwent STER using the AIO device.

Zoom
Fig. 2 Endoscopic view of the esophageal submucosal tumor at 21 cm from the incisors.

A longitudinal incision was made 2 cm proximally to the lesion using the AIO ESD knife and a submucosal tunnel leading to the lesion was meticulously established until clear visualization of the lesion being continuous with the muscular layer was achieved. To preserve lesion integrity, careful dissection between the tumor and the submucosal layer was performed using the AIO ESD knife, followed by complete resection from the esophageal serosa using an insulation-tipped knife. The intraoperative supplementary injection function of the AIO device facilitated precise tissue plane identification. The resected specimen was successfully retrieved via the AIO snare probe. The mucosal entry was closed with metal clips after hemostasis ([Video 1]). The total operation time was 37 minutes. The patient experienced no postoperative complications (bleeding, perforation, or fistula) and was discharged after 48 hours of observation. The pathological diagnosis confirmed leiomyoma.

Download
Demonstration of the submucosal tunneling endoscopic resection procedure using the all-in-one device for the resection of an esophageal leiomyoma.Video 1

To the best of our knowledge, this case represents the first successful clinical implementation of the AIO device in STER, demonstrating its convenience, operational efficiency, and safety profile. However, further research is needed.

Endoscopy_UCTN_Code_TTT_1AO_2AG_3AZ

Endoscopy E-Videos https://eref.thieme.de/e-videos

E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/).

This section has its own submission website at https://mc.manuscriptcentral.com/e-videos.


 

Conflict of Interest

The authors declare that they have no conflict of interest.


Correspondence

Ming-Yan Cai, MD, PhD
Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital Fudan University
180 Fenglin Road
Shanghai 200032
China   

Publication History

Article published online:
01 July 2025

© 2025. 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/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany


  Permissions and Reprints
Zoom
Fig. 1 The all-in-one device integrates electrosurgical dissection, intraoperative supplementary injection, and snaring, reducing the need for intraprocedural instrument changes. ESD, endoscopic submucosal dissection.
Zoom
Fig. 2 Endoscopic view of the esophageal submucosal tumor at 21 cm from the incisors.