Endoscopy 2017; 49(S 01): E86-E87
DOI: 10.1055/s-0043-100212
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© Georg Thieme Verlag KG Stuttgart · New York

Submucosal tunneling endoscopic resection (STER) with full-thickness muscle excision for a recurrent para-aortic esophageal leiomyoma after surgery

Gianfranco Donatelli
1   Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
,
David Fuks
2   Department of Digestive Surgery, Institut Mutualiste Monsouris, Univeristé Paris Descartes, Paris, France
,
Guillaume Pourcher
2   Department of Digestive Surgery, Institut Mutualiste Monsouris, Univeristé Paris Descartes, Paris, France
,
Isabelle Dumontier
1   Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
,
Fabrizio Cereatti
1   Unité d’Endoscopie Interventionnelle, Ramsay Générale de Santé, Hôpital Privé des Peupliers, Paris, France
,
Thierry Perniceni
2   Department of Digestive Surgery, Institut Mutualiste Monsouris, Univeristé Paris Descartes, Paris, France
,
Brice Gayet
2   Department of Digestive Surgery, Institut Mutualiste Monsouris, Univeristé Paris Descartes, Paris, France
› Author Affiliations
Further Information

Corresponding author

Gianfranco Donatelli, MD
Unité d’Endoscopie Interventionnelle
Ramsay Générale de Santé
Hôpital Privé des Peupliers
8 Place de l’Abbé G. Hénocque
75013 Paris
France   
Fax: + 33-1-44165615   

Publication History

Publication Date:
13 February 2017 (online)

 

We report the case of a 49-year-old woman with a recurrent esophageal leiomyoma following two surgical resections. The surgical procedures had been performed 23 and 21 years previously. Follow-up showed lesion recurrence in the mid esophagus ([Fig. 1] and [Fig. 2]).

Zoom Image
Fig. 1 Endoscopic view showing a recurrent leiomyoma in the mid-esophagus.
Zoom Image
Fig. 2 Endoscopic ultrasound (EUS) showing a huge para-aortic leiomyoma developing from the muscularis propria layer.

Submucosal endoscopic tunneling resection (STER) was preferred to surgery because of the previous interventions. A single shot of 2 g ceftriaxone was administered intravenously prior to the procedure. Submucosal injection, mucosal incision, and tunnel creation was started 5 cm above the lesion. Enucleation was performed using a DualKnife J (Olympus, Tokyo, Japan). The lesion was close to the aorta, so the final dissection was carried out by synchronizing with aortic movements. Full-thickness muscle resection was required to achieve en bloc resection being careful to preserve the esophageal adventitia ([Video 1]). The leiomyoma was grasped with a 30-mm snare and was easily removed ([Fig. 3]). Six standard clips (QuickClip Pro; Olympus) were deployed to close the mucosal incision.

Video 1: Peroral endoscopic tunneling dissection of a huge recurrent para-aortic esophageal leiomyoma. Muscularis propria dissection and full-thickness resection was necessary to mobilize the lesion with preservation of the esophageal adventitia.

Quality:
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Fig. 3 Endoscopic view showing the 15 × 30-mm leiomyoma being grasped by a 30-mm snare.

A computed tomography (CT) scan with swallow study was performed on postoperative day 1; oral diet was restarted on day 2. Histological examination did not show any malignancy.

Tumors originating from the muscularis propria require surgery in most cases [1]. STER is a novel approach for the treatment of subepithelial tumors of the gastrointestinal tract. The risk of perforation may reach up to 15 % [2]. If the tumor develops from the muscularis propria, preservation of the serosal layer is difficult; circumferential incision of the serosa is therefore often required to complete en bloc resection [3]. Even though a large muscular defect exists, mediastinitis does not occur if the mucosal continuity is maintained [4].

Recurrent esophageal leiomyoma has been anecdotally reported and is usually related to incomplete resection or enlargement of a previously undetected nodule [5]. Here, we report the first STER treatment for recurrent esophageal leiomyoma with full-thickness muscle resection, which was required because of involvement of the deep muscularis propria and fibrosis deriving from previous surgery.

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Competing interests

None

  • References

  • 1 Eleftheriadis N, Inoue H, Ikeda H. et al. Submucosal tunnel endoscopy: Peroral endoscopic myotomy and peroral endoscopic tumor resection. World J Gastrointest Endosc 2016; 8: 86-103
  • 2 Chiu PW, Inoue H, Rösch T. From Poem to Poet: Applications and perspectives for submucosal tunnel endoscopy. Endoscopy 2016; 48: 1134-1142
  • 3 Xu MD, Cai MY, Zhou PH. et al. Submucosal tunneling endoscopic resection: a new technique for treating upper GI submucosal tumors originating from the muscularis propria layer (with videos). Gastrointest Endosc 2012; 75: 195-199
  • 4 Inoue H, Ikeda H, Hosoya T. et al. Submucosal endoscopic tumor resection for subepithelial tumors in the esophagus and cardia. Endoscopy 2012; 44: 225-230
  • 5 Standerfer RJ, Paneth M. Recurrent leiomyoma of the oesophagus. Thorax 1982; 37: 478-479

Corresponding author

Gianfranco Donatelli, MD
Unité d’Endoscopie Interventionnelle
Ramsay Générale de Santé
Hôpital Privé des Peupliers
8 Place de l’Abbé G. Hénocque
75013 Paris
France   
Fax: + 33-1-44165615   

  • References

  • 1 Eleftheriadis N, Inoue H, Ikeda H. et al. Submucosal tunnel endoscopy: Peroral endoscopic myotomy and peroral endoscopic tumor resection. World J Gastrointest Endosc 2016; 8: 86-103
  • 2 Chiu PW, Inoue H, Rösch T. From Poem to Poet: Applications and perspectives for submucosal tunnel endoscopy. Endoscopy 2016; 48: 1134-1142
  • 3 Xu MD, Cai MY, Zhou PH. et al. Submucosal tunneling endoscopic resection: a new technique for treating upper GI submucosal tumors originating from the muscularis propria layer (with videos). Gastrointest Endosc 2012; 75: 195-199
  • 4 Inoue H, Ikeda H, Hosoya T. et al. Submucosal endoscopic tumor resection for subepithelial tumors in the esophagus and cardia. Endoscopy 2012; 44: 225-230
  • 5 Standerfer RJ, Paneth M. Recurrent leiomyoma of the oesophagus. Thorax 1982; 37: 478-479

Zoom Image
Fig. 1 Endoscopic view showing a recurrent leiomyoma in the mid-esophagus.
Zoom Image
Fig. 2 Endoscopic ultrasound (EUS) showing a huge para-aortic leiomyoma developing from the muscularis propria layer.
Zoom Image
Fig. 3 Endoscopic view showing the 15 × 30-mm leiomyoma being grasped by a 30-mm snare.