Endoscopic resection of submucosal esophageal tumors: a prospective case series

BACKGROUND AND STUDY AIM: The introduction of endoscopic ultrasound (EUS) and endoscopic mucosal resection has offered a new alternative to simple observation or surgical resection for the management of esophageal submucosal tumors. PATIENTS AND METHODS: During a 4-year period, endoscopic resection was attempted in 20 consecutive patients (nine women, 11 men; mean age 52 +/- 10 years) with esophageal submucosal tumors < 4 cm in size, confirmed by endoscopy and miniprobe EUS (20 MHz). The mean tumor diameter was 17 +/- 8 mm (8 - 34 mm). Prior EUS-guided cytological examination revealed benign tumors in 11 patients; however, endoscopic resection was attempted in most patients for diagnostic purposes also. Several patients were symptomatic (retrosternal pain, n = 4; dysphagia, n = 4; recurrent bleeding, n = 2) but most tumors had been detected incidentally. RESULTS: In the majority of patients the tumor was ligated with a rubber band and then resected with a snare (n = 11), and in the others simple snare resection ("lift-and-cut," n = 7) or cap resection (n = 2) was done. A macroscopically complete endoscopic resection was achieved in 19/20 patients, and the remaining patient was managed surgically. Endoscopic hemostasis was necessary (and successful) in eight patients (40 %), but blood transfusion was not required. No other side effects occurred. Histological examination revealed granular cell tumor in 12 patients, leiomyoma in six patients, and a lipoma and stromal tumor in one patient each. Histologically, all tumors were judged to be benign and a microscopically complete resection (R0) was achieved in all patients, with the exception of the one patient with a stromal tumor. Thus, surgical resection was necessary in only two of the 20 patients (10 %). During the median prospective follow-up of 12 months no tumor recurrence was detected in any patient. CONCLUSION: Endoscopic resection of esophageal submucosal tumors is safe and effective. The probability of achieving curative resection (R0 resection, histologically benign) is high especially if the tumors are smaller in size (< 4 cm).