1
|
Ye T, Zong Y, Zhao G, Zhou A, Yue B, Zhao H, Li P. Role of Endoscopy in Esophageal Tuberculosis: A Narrative Review. J Clin Med 2022; 11:jcm11237009. [PMID: 36498584 PMCID: PMC9740747 DOI: 10.3390/jcm11237009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 11/29/2022] Open
Abstract
Esophageal tuberculosis (ET) is a rare infectious disease of the gastrointestinal tract. Awareness of ET is deficient due to its low incidence. Unexplained dysphagia and upper gastrointestinal bleeding are the most common symptoms of ET. The prognosis is generally good if patients are diagnosed properly and receive anti-tubercular treatment promptly. However, ET is difficult to differentiate from other diseases. Endoscopic techniques such as esophagogastroduodenoscopy (EGD), endoscopic ultrasonography (EUS), contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS), elastography, and endoscopic ultrasound--guided fine-needle aspiration (EUS-FNA) improve the diagnosis of ET. Thus, the characteristics of ET and other difficult-to-detect diseases according to EGD and EUS were summarized. Intriguingly, there is no literature relevant to the application of CH-EUS and elastography in ET. The authors' research center was first in introducing CH-EUS and elastography into the field of ET. The specific manifestation of ET based on CH-EUS was discovered for the first time. Correlative experience and representative cases were shared. The role of endoscopy in acquiring esophageal specimens and treatment for ET was also established. In this review, we aim to introduce a promising technology for the diagnosis and treatment of ET.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Peng Li
- Correspondence: (H.Z.); (P.L.)
| |
Collapse
|
2
|
Peixoto A. Large incidental esophageal leiomyoma: Radiological findings. Radiol Case Rep 2022; 17:4417-4420. [PMID: 36188074 PMCID: PMC9520497 DOI: 10.1016/j.radcr.2022.08.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 08/18/2022] [Accepted: 08/21/2022] [Indexed: 10/28/2022] Open
|
3
|
Pan W, Wu J, Liu C, He Y, Yang J. Esophageal low-grade intraepithelial neoplasia overlying multiple leiomyomas: A case report and review of the literature. Front Oncol 2022; 12:994005. [PMID: 36387267 PMCID: PMC9659895 DOI: 10.3389/fonc.2022.994005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/03/2022] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND Esophageal leiomyoma is the most common benign submucosal mesenchymal tumor. Esophageal intraepithelial neoplasia includes low-grade and high-grade intraepithelial neoplasia. The coexistence of epithelial lesions and the subepithelial lesion is rare. We recorded a case of esophageal low-grade intraepithelial neoplasia (LGIN) overlying multiple esophageal leiomyomas and followed with a review of the literature. CASE PRESENTATION A 49-year-old female patient came for the treatment of esophageal lesions. The submucosal eminences were observed in the right posterior wall and the left anterior wall of the esophagus by Esophagogastroduodenoscopy (EGD). Additionally, we noticed the mucosa of the right wall with brown background color and the dilated, tortuous vessels by narrow-band imaging (NBI). Then we ensured that the submucosal lesions originated from the esophageal mucosal muscle by endoscopic ultrasonography (EUS) and enhanced CT. Subsequently, the submucosal eminence of the right posterior wall and the overlying mucosal lesion were removed together by endoscopic submucosal dissection (ESD). Postoperative pathological diagnosed esophageal submucosal leiomyoma with focal LGIN. Review EGD showed white scars on the right wall of the upper esophagus three months later, while pathological biopsy showed slight squamous epithelial hyperplasia in the left wall. We decided that the left submucosal lesion can be resected at a selective-time operation, and we continue to follow up as planned. CONCLUSIONS The case of intraepithelial neoplasia overlying the submucosal tumor is rare. Either missed diagnosis or overdiagnosis should be avoided through EGD and pathological biopsy.
Collapse
Affiliation(s)
- Wen Pan
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu, China
- Department of Gastroenterology and Hepatology, The Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu, China
| | - Junchao Wu
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu, China
| | - Chao Liu
- Department of Gastroenterology and Hepatology, The Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu, China
| | - Yanjun He
- Department of Pathology, The Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu, China
| | - Jinlin Yang
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu, China
| |
Collapse
|
4
|
Fan X, Jiao J, Luo L, Zhu L, Zheng Z, Chen X, Wang T, Liu W, Wang B. Role of endoscopic ultrasound and endoscopic resection in the diagnosis and treatment of esophageal granular cell tumors. Scand J Gastroenterol 2022; 57:1264-1271. [PMID: 35576559 DOI: 10.1080/00365521.2022.2067784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Diagnosis and complete resection of esophageal granular cell tumors (GCTs) is an area of concern. However, articles on endoscopic ultrasound (EUS) and endoscopic resection of esophageal granular cell tumors are few. To evaluate the role of endoscopic ultrasound and endoscopic resection in the diagnosis and treatment of esophageal granular cell tumors. METHODS A retrospective analysis of 15 patients with esophageal granular cell tumors who underwent endoscopic ultrasound examination and endoscopic resection in our hospital was conducted. The clinical data, endoscopic ultrasound images, endoscopic treatment, pathological characteristics, postoperative complications and follow-up status of all patients were evaluated. Ten board-certified endoscopists independently evaluated the white light endoscopic images of the 15 patients (Test 1) and the endoscopic ultrasound images together with white light endoscopic images of the same patient set (Test 2). RESULT Female patients accounted for 53.4% of the participants. The average age at the time of diagnosis was 49.13 ± 9.31 years old. Ten lesions (66.67%) showed hypoechoic signal, four lesions (26.67%) showed hyperechoic signal and one lesion showed medium signal. The diagnostic accuracy was significantly higher with Test 2(65.3% vs. 92.0%, p < .001). Complete endoscopic resection was performed in all the patients. No complications occurred in any of the patients. No esophageal stenosis, recurrence, or metastases was found in all patients during the follow-up period. CONCLUSION The endoscopic ultrasound images of esophageal granular cell tumors have certain characteristics that help diagnose esophageal granular cell tumors. Endoscopic resection of esophageal granular cell tumors is an effective, safe and feasible treatment method.
Collapse
Affiliation(s)
- Xiaofei Fan
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China.,Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Tianjin, China
| | - Jiao Jiao
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China.,Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Tianjin, China
| | - Lili Luo
- Department of Geriatric, General Hospital, Tianjin Medical University, Tianjin, China
| | - Lanping Zhu
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China.,Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Tianjin, China
| | - Zhongqing Zheng
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China.,Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Tianjin, China
| | - Xin Chen
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China.,Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Tianjin, China
| | - Tao Wang
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China.,Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Tianjin, China
| | - Wentian Liu
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China.,Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Tianjin, China
| | - Bangmao Wang
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China.,Institute of Digestive Diseases, Tianjin Key Laboratory of Digestive Diseases, Tianjin, China
| |
Collapse
|
5
|
Kang S, Kim DH, Kim Y, Jeon D, Na HK, Lee JH, Ahn JY, Jung KW, Choi KD, Song HJ, Lee GH, Jung HY. Natural History of Asymptomatic Esophageal Subepithelial Tumors of 30 mm or Less in Size. J Korean Med Sci 2022; 37:e184. [PMID: 35698837 PMCID: PMC9194489 DOI: 10.3346/jkms.2022.37.e184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 05/16/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND No definite guidelines for the management of small esophageal subepithelial tumors (SETs) have been established, because there are limited data and studies on their natural history. We aimed to assess the natural history and propose optimal management strategies for small esophageal SETs. METHODS Patients diagnosed as esophageal SETs ≤ 30 mm in size between 2003 and 2017 using endoscopic ultrasound (EUS) with a minimal follow-up of 3 months were enrolled, and their esophagogastroduodenoscopy (EGD) and EUS were retrospectively reviewed. RESULTS Of 275 esophageal SETs in 262 patients, the initial size was < 10 mm, 10-20 mm, and 20-30 mm in 104 (37.8%), 105 (38.2%), and 66 (24.0%) lesions, respectively. Only 22 (8.0%) SETs showed significant changes in size and/or echogenicity and/or morphology at a median of 40 months (range, 4-120 months). Tissues of 6 SETs showing interval changes were obtained using EUS-guided fine needle aspiration biopsy; 1 was identified as a gastrointestinal stromal tumor (GIST) and was surgically resected, while the other 5 were leiomyomas and were regularly observed. Eight SETs showing interval changes were resected surgically or endoscopically without pathological confirmation; 1 was a GIST, 2 were granular cell tumors, and the other 5 were leiomyomas. CONCLUSION Regular follow-up with EGD or EUS may be necessary for esophageal SETs ≤ 30 mm in size considering that small portion of them has a possibility of malignant potential. When esophageal SETs ≤ 30 mm show significant interval changes, pathological confirmation may precede treatment to avoid unnecessary resection.
Collapse
Affiliation(s)
- Seokin Kang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Yuri Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dongsub Jeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Kyong Na
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
6
|
Jia Y, Zhang Q, Li E, Zhang Z, Chen X. Submucosal oesophageal squamous cell carcinoma with lymph node metastasis: a case report and literature review. BMC Gastroenterol 2022; 22:97. [PMID: 35240995 PMCID: PMC8895913 DOI: 10.1186/s12876-022-02169-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/18/2022] [Indexed: 11/27/2022] Open
Abstract
Background Submucosal oesophageal squamous cell carcinoma is a quite infrequent and special type of oesophageal cancer. Its endoscopic manifestations are similar to those of submucosal oesophageal lesions, so it is easily ignored or misdiagnosed. Thus, the exact and timely diagnosis of oesophageal subepithelial lesions (SELs) is crucial. Endoscopic submucosal dissection (ESD) improves the diagnosis rate of malignant SELs without specific endoscopic presentations. Case presentation We report a 63-year-old patient with submucosal lesions of the oesophagus under endoscopy, but CT suggested mediastinal lymphadenectasis. Thus, there was a contradiction between them. After multidisciplinary consultation, endoscopic submucosal dissection (ESD) resection was finally recommended. The lesion was completely resected by endoscopic submucosal dissection. Postoperative pathology reported poorly differentiated squamous cell carcinoma, and subsequent PET-CT examination provided clarity, revealing mediastinal lymph node metastasis. Conclusions Not all oesophageal SELs are benign, and a small number of SELs can be malignant. Submucosal oesophageal squamous cell carcinoma is a rare disease that may be characterized by oesophageal subepithelial lesions (SELs). Therefore, the precise and timely diagnosis of SELs is essential. If it is necessary to obtain lesion tissue for a definite diagnosis, ESD with less invasiveness is an excellent choice.
Collapse
Affiliation(s)
- Yuting Jia
- Department of Endoscopy Center, Shanxi Cancer Hospital, Taiyuan, China
| | - Quanmao Zhang
- Department of Endoscopy Center, Shanxi Cancer Hospital, Taiyuan, China
| | - Erfeng Li
- Department of Endoscopy Center, Shanxi Cancer Hospital, Taiyuan, China
| | - Zhen Zhang
- Department of Pathology, Shanxi Cancer Hospital, Taiyuan, China
| | - Xing Chen
- Department of Endoscopy Center, Shanxi Cancer Hospital, Taiyuan, China.
| |
Collapse
|
7
|
Froiio C, Berlth F, Capovilla G, Tagkalos E, Hadzijusufovic E, Mann C, Lang H, Grimminger PP. Robotic-assisted surgery for esophageal submucosal tumors: a single-center case series. Updates Surg 2022; 74:1043-1054. [PMID: 35147859 PMCID: PMC9213313 DOI: 10.1007/s13304-022-01247-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/15/2022] [Indexed: 11/21/2022]
Abstract
Esophageal submucosal tumors (SMTs) are rare heterogenous clinical entities. The surgical resection can be performed in different surgical approaches. However, the robotic surgical strategy is poorly documented in the treatment of SMTs. We present our series of operated esophageal SMTs approached via robotic-assisted surgery. Six patients with symptomatic esophageal submucosal tumors underwent robotic surgery within a 3-year period. The performed procedures were robotic-assisted enucleation, robotic esophagectomy (RAMIE) and reverse hybrid robotic esophagectomy. Patients’ clinical data, intra/postoperative outcomes, and histopathological features were retrieved from the institution’s prospective database. Five of six patients were scheduled for upfront surgery: four underwent robotic enucleation (three leiomyoma and one suspected GIST) and one underwent reverse hybrid robotic esophagectomy (suspected GIST). One patient, diagnosed with GIST, was treated with neoadjuvant Imatinib therapy, before undergoing a RAMIE. No major intra-operative complications were recorded. Median length of stay was 7 days (6–50), with a longer post-operative course in patients who underwent esophagectomy. Clavien–Dindo > 3a complications occurred in two patients, aspiration pneumonia and delayed gastric emptying. The final histopathological and immuno-histochemical diagnosis were leiomyoma, well-differentiated GIST, low-grade fibromyxoid sarcoma and Schwannoma. Robotic-assisted surgery seems to be a promising option for surgical treatment strategies of benign or borderline esophageal submucosal tumors.
Collapse
Affiliation(s)
- Caterina Froiio
- Mainz University, Johannes Gutenberg Universitat Mainz, Mainz, Germany.,Department of General Surgery , IRCCS Policlinico San Donato, University of Milan , Milano, Italy
| | - Felix Berlth
- Mainz University, Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | | | | | | | - Carolina Mann
- Mainz University, Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | - Hauke Lang
- Mainz University, Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | | |
Collapse
|
8
|
Zhao L, Zhang X, Gao C, He J, Han Z, Li L. A comparison of bronchial blocker under artificial pneumothorax and double-lumen endobronchial tube for lung isolation in thoracoscopic enucleation of oesophageal leiomyoma. J Cardiothorac Surg 2021; 16:322. [PMID: 34719379 PMCID: PMC8559383 DOI: 10.1186/s13019-021-01707-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/27/2021] [Indexed: 12/16/2022] Open
Abstract
Background Oesophageal leiomyomas are one of the most common benign oesophageal tumours. This retrospective, observational study summarized and compared the clinical outcomes of thoracoscopic enucleation of oesophageal leiomyoma between single-lumen endotracheal intubation with a bronchial blocker and double-lumen endotracheal intubation. Methods A total of 36 patients who underwent thoracoscopic enucleation of oesophageal leiomyoma at Peking Union Medical College Hospital between 2014 and 2020 were retrospectively analysed. Fifteen patients received single-lumen endotracheal intubation combined with a right bronchial blocker (SLT-B group), and twenty-one patients received double-lumen endotracheal intubation (DLT group). Clinical data, surgical variables, and postoperative complications were analysed and compared. Results The average tumour size in all patients was 4.3 ± 2.0 cm. The average tumour size among symptomatic patients was significantly larger than that among asymptomatic patients (5.1 ± 2.0 cm vs 3.7 ± 1.7 cm, P < 0.05). Patients in the SLT-B group had a significantly larger average tumour size than patients in the DLT group (5.4 ± 2.1 cm vs 3.5 ± 1.4 cm, P < 0.05). The SLT-B group had a significantly shorter operation time and shorter total hospital stay than the DLT group. No mucosal injury, conversion to thoracotomy, or other operative complications occurred in the SLT-B group. In the follow-up, no recurrence, dysphagia, or regurgitation was found in any of the patients. Conclusions Compared with traditional double-lumen intubation, artificial pneumothorax-assisted single-lumen endotracheal intubation combined with a bronchial blocker for thoracoscopic oesophageal leiomyoma enucleation can achieve complete removal of larger tumours, with fewer complications and shorter hospital stays.
Collapse
Affiliation(s)
- Luo Zhao
- Department of Thoracic Surgery, Peking Union Medical College Hospital, CAMS & PUMC, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Xue Zhang
- Department of Anaesthesiology, Peking Union Medical College Hospital, CAMS & PUMC, Beijing, 100730, China
| | - Chao Gao
- Department of Thoracic Surgery, Peking Union Medical College Hospital, CAMS & PUMC, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Jia He
- Department of Thoracic Surgery, Peking Union Medical College Hospital, CAMS & PUMC, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Zhijun Han
- Department of Thoracic Surgery, Peking Union Medical College Hospital, CAMS & PUMC, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Li Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, CAMS & PUMC, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
| |
Collapse
|
9
|
Mishra S, Jain N, Soni B, Bajaj D, Khetan A, Sharma B, Bhojwani R. Thoracoscopic enucleation of oesophageal submucosal tumours in prone position gives excellent long-term outcome: A single-centre experience. J Minim Access Surg 2021; 18:401-407. [PMID: 35046167 PMCID: PMC9306123 DOI: 10.4103/jmas.jmas_169_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Thoracoscopic enucleation of oesophageal leiomyomas has been adopted by many centres. The procedure when performed in prone position gives good results. The long-term outcome has not been reported earlier. This single-centre study establishes the role of this particular technique. Methods: A retrospective analysis of a prospectively maintained hospital database was performed and after following the study criteria eleven cases of oesophageal submucosal tumours were included in the study. All patients underwent thoracoscopic enucleation in the prone position by a single surgeon. Peri-operative data were recorded and patients followed up for a mean period of 78 months (range = 24–120 months). Results: Thoracoscopic enucleation in prone position was done for all patients with no conversions to an open procedure. Two patients had a mucosal rent during dissection that was repaired. There was no post-operative morbidity greater than Clavien-Dindo Grade 2. Long-term follow-up is available for eight patients (73%) with no recurrence of disease or symptoms. Conclusion: Oesophageal submucosal tumours (predominantly leiomyomas) are benign neoplasms with an indolent biological behaviour and deserve a procedure that would serve the purpose of minimal post-operative morbidity coupled with excellent outcome. Thoracoscopic enucleation in the prone position provides a physiological benefit that translates into better peri-operative outcomes without compromising the long-term outcome and should be the preferred form of treatment for oesophageal submucosal tumours.
Collapse
Affiliation(s)
- Siddharth Mishra
- Department of Surgical Gastroenterology and Minimal Invasive Surgery, Santokba Durlabhji Memorial Hospital and Medical Research Centre, Santokba Institute of Digestive Surgical Sciences, Jaipur, Rajasthan, India
| | - Nikhil Jain
- Department of Surgical Gastroenterology and Minimal Invasive Surgery, Santokba Durlabhji Memorial Hospital and Medical Research Centre, Santokba Institute of Digestive Surgical Sciences, Jaipur, Rajasthan, India
| | - Bansidhar Soni
- Department of Surgical Gastroenterology and Minimal Invasive Surgery, Santokba Durlabhji Memorial Hospital and Medical Research Centre, Santokba Institute of Digestive Surgical Sciences, Jaipur, Rajasthan, India
| | - Deepak Bajaj
- Department of Surgical Gastroenterology and Minimal Invasive Surgery, Santokba Durlabhji Memorial Hospital and Medical Research Centre, Santokba Institute of Digestive Surgical Sciences, Jaipur, Rajasthan, India
| | - Ashish Khetan
- Department of Surgical Gastroenterology and Minimal Invasive Surgery, Santokba Durlabhji Memorial Hospital and Medical Research Centre, Santokba Institute of Digestive Surgical Sciences, Jaipur, Rajasthan, India
| | - Bhuwanesh Sharma
- Department of Surgical Gastroenterology and Minimal Invasive Surgery, Santokba Durlabhji Memorial Hospital and Medical Research Centre, Santokba Institute of Digestive Surgical Sciences, Jaipur, Rajasthan, India
| | - Rajesh Bhojwani
- Department of Surgical Gastroenterology and Minimal Invasive Surgery, Santokba Durlabhji Memorial Hospital and Medical Research Centre, Santokba Institute of Digestive Surgical Sciences, Jaipur, Rajasthan, India
| |
Collapse
|
10
|
Role of endoscopic ultrasonography for differential diagnosis of upper gastrointestinal submucosal lesions. BMC Gastroenterol 2021; 21:365. [PMID: 34620107 PMCID: PMC8495965 DOI: 10.1186/s12876-021-01945-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/27/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To determine the accuracy of endoscopic ultrasonography (EUS) in the diagnosis of upper gastrointestinal submucosal lesions (SMLs). METHODS This was a retrospective study involving patients diagnosed with SMLs using EUS and confirmed by histopathology from November 2014 to December 2020 at The Third Xiangya Hospital of Central South University. RESULTS A total of 231 patients with SMLs were examined by EUS. Histologically, 107 lesions were stromal tumors, and 75 lesions were leiomyomas. Stromal tumors were mainly located in the stomach (89.7%), and leiomyomas were predominantly seen in the esophagus (69.3%). The diagnostic accuracy of EUS for stromal tumors and leiomyomas was 80.4% and 68.0%, respectively. The diagnostic accuracy was highest for lesions located in the muscularis mucosa. The mean diameter of stromal tumors measured using EUS was significantly larger than that of leiomyomas (21.89 mm vs. 12.35 mm, p < 0.001). Stromal tumors and leiomyomas originated mainly from the muscularis propria (94.4%) and the muscularis mucosa (56.0%), respectively. Compared with the very low-risk and low-risk groups of stromal tumors according to the National Institute of Health guidelines, the intermediate-risk and high-risk groups were more likely to have a lesion > 3 cm (p < 0.001) and a surface ulcer (p < 0.01) identified by EUS. CONCLUSIONS EUS has good diagnostic value for the diagnosis of upper gastrointestinal SMLs based on the lesion size and the muscle layer of origin. The diagnostic accuracy of EUS lesions is related to the origin, and the diagnostic accuracy is greatest in the mucosal muscularis layer. Stromal tumors > 3 cm and a surface ulcer on EUS are likely to be intermediate or high risk for invasion.
Collapse
|
11
|
Huan Pham D, Dan Nguyen N, Mai Lam D, Xuan Hoa N, Van Kien Q, Bretagnol F, Fingerhut A, Leroy J. Video assisted thoracoscopy or laparoscopy for enucleation of esophageal leiomyoma: A seven-year single center experience of 75 cases. J Visc Surg 2021; 159:108-113. [PMID: 34446363 DOI: 10.1016/j.jviscsurg.2021.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Leiomyoma is the most common benign tumor of the esophagus. Extra mucosal enucleation is the standard treatment. Herein we evaluated the feasibility and the outcomes of Minimally Invasive Surgery (MIS) using video-assisted thoracoscopic (VATS) or laparoscopic surgery (VALS) for esophageal leiomyoma enucleation. SUBJECTS AND METHODS Retrospective study of patients who were treated via VATS or VALS for esophageal leiomyoma enucleation in "Hanoi Viet Duc Hospital" from 2010 to 2017 by the same operator. The operative approach, tumor size, complications and outcomes after surgery were recorded. RESULTS Seventy-five patients were included. Mean age was 41.9 (range 20-68) years. The male/female sex ratio was 2.1:1. Fifty-five patients had clinical symptoms (73.3%). Tumors were identified in the upper third (12%), middle third (51%), and lower third (37%) of the esophagus. Mean tumor size was 3.7 (range 2-11) cm. VALS enucleation was performed in 23 patients who had leiomyoma located near the cardia (gastroesophageal junction or abdominal esophagus). The remaining 52 patients underwent right (n=42) or left VATS (n=10). Five patients (6.7%) sustained esophageal mucosa injury during dissection, repaired by MIS without late morbidity. A mini-incision (2 mini-laparotomies and 1 thoracotomy) was required in three patients (4%) due to large tumor size or mucosal injury. The mean operative time was 105min in VATS and 174min in VALS. No major perioperative surgical or medical complications were reported. The mean duration of hospital stay was 7.2 (range 5-12) days. CONCLUSIONS MIS enucleation of esophageal leiomyoma is technically safe and associated with a high therapeutic success rate with low medico-surgical morbidity. VATS could be applied for almost all esophageal leiomyoma tumors; however, the VALS approach was preferred for tumors located near the gastroesophageal junction in order to create an anti-reflux valve after enucleation.
Collapse
Affiliation(s)
- D Huan Pham
- Department of Surgery, Hanoi Medical University, 1, rue Ton That Tung, Kim Lien, Dong Da, Hanoi, Viet Nam
| | - N Dan Nguyen
- Department of Surgery, Hanoi Medical University, 1, rue Ton That Tung, Kim Lien, Dong Da, Hanoi, Viet Nam; Hôpital Saint Paul, 12, Rue Chu Van An Hanoi, Hanoi, Viet Nam.
| | - D Mai Lam
- Viet Duc University Hospital, 40, rue Trang Thi, Hoan Kiem, Hanoi, Viet Nam
| | - N Xuan Hoa
- Viet Duc University Hospital, 40, rue Trang Thi, Hoan Kiem, Hanoi, Viet Nam
| | - Q Van Kien
- Department of Surgery, Hanoi Medical University, 1, rue Ton That Tung, Kim Lien, Dong Da, Hanoi, Viet Nam
| | - F Bretagnol
- Hôpital Louis Mourier (AP-HP), Paris, France
| | | | - J Leroy
- Department of Surgery, Hanoi Medical University, 1, rue Ton That Tung, Kim Lien, Dong Da, Hanoi, Viet Nam
| |
Collapse
|
12
|
Ravi K. Artificial intelligence: finding the intersection of predictive modeling and clinical utility. Gastrointest Endosc 2021; 93:1273-1275. [PMID: 33691975 DOI: 10.1016/j.gie.2020.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/03/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Karthik Ravi
- Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| |
Collapse
|
13
|
Padmanabhan N, Kurian A, Hussain A, Rajarajan V, Pai A. Giant Gastroesophageal Leiomyoma: Challenges in Diagnosis and Management. J Gastrointest Cancer 2021; 51:1039-1043. [PMID: 32144541 DOI: 10.1007/s12029-020-00387-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Naveen Padmanabhan
- Department of Surgical Oncology, Apollo Cancer Institutes, No. 35, Padma Complex, Anna Salai, Chennai, 600035, India.
| | - Ann Kurian
- Department of Pathology, Apollo Cancer Institutes, Chennai, 600035, India
| | - Aasim Hussain
- Department of GI Surgery, Apollo Cancer Institutes, Chennai, 600035, India
| | - V Rajarajan
- Department of Vascular Surgery, Apollo Hospitals, Chennai, 600035, India
| | - Ajit Pai
- Department of Surgical Oncology, Apollo Cancer Institutes, No. 35, Padma Complex, Anna Salai, Chennai, 600035, India
| |
Collapse
|
14
|
Zhu H, Shi B, Li F, Xu H. Esophageal intramural squamous cell carcinomas presenting as subepithelial lesions removed by endoscopic submucosal dissection: Two case reports. Medicine (Baltimore) 2020; 99:e21850. [PMID: 33157909 PMCID: PMC7647628 DOI: 10.1097/md.0000000000021850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Esophageal subepithelial lesions (SELs) are rare, and the majority of them are benign. SELs are often covered with normal mucosa, thereby resulting in some malignant SELs to be easily missed or misdiagnosed. We report 2 cases of esophageal intramural squamous cell carcinomas (SCCs) that presented as SELs and were endoscopically removed. PATIENT CONCERNS Case 1 is a 63-year-old man with abdominal distension; case 2 is a 65-year-old man with increasing dysphagia for 2 months. DIAGNOSIS In case 1, endoscopy showed a 1.5-cm mucosal eminence with normal overlying mucosa. Endoscopic ultrasound (EUS) revealed that it might be derived from the muscularis mucosa or submucosa. In case 2, endoscopy revealed a 1.2-cm hemispherical lesion covered with smooth mucosa. Furthermore, EUS revealed that this lesion might be derived from the submucosa. INTERVENTIONS In both cases, the lesions were removed by endoscopic submucosal dissection (ESD). Pathological examination revealed esophageal SCC nests with intramural growth patterns. OUTCOMES The first patient underwent postoperative radiotherapy, whereas the second patient did not receive any additional treatment. Both patients agreed to regular follow-up, and no tumor recurrence or metastasis was observed. CONCLUSION First, not all esophageal SELs are benign, and a small number of SELs can be malignant. Second, these cases illustrate the value of newer endoscopic techniques, especially ESD. Thus, it is important to be alert when visualizing the esophagus for the possibility of a subtle SEL so that further evaluation and treatment, if necessary, can be undertaken, ideally with a less invasive approach afforded by ESD.
Collapse
|
15
|
Vaicekauskas R, Urbonienė J, Stanaitis J, Valantinas J. Evaluation of Upper Endoscopic and Endoscopic Ultrasound Features in the Differential Diagnosis of Gastrointestinal Stromal Tumors and Leiomyomas in the Upper Gastrointestinal Tract. Visc Med 2020; 36:318-324. [PMID: 33005658 DOI: 10.1159/000504327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/21/2019] [Indexed: 12/12/2022] Open
Abstract
Background Differentiation between benign and malignant subepithelial lesions (SELs) in the upper gastrointestinal tract (UGT) leads to far-reaching clinical consequences. An accurate diagnosis can be challenging because of the insufficient diagnostic yield of upper endoscopy, endoscopic ultrasound (EUS), and different types of biopsy. Aim Our aim was to reveal the efficacy of upper endoscopic and EUS features for the differential diagnosis of hypoechogenic SELs (gastrointestinal stromal tumors [GISTs] and leiomyomas) in the UGT. Materials and Methods The research covers a case series study of 27 hypoechogenic SELs in the UGT between 2012 and 2015 at Vilnius University Hospital Santaros Klinikos. Upper endoscopic and EUS features of SELs were recorded. In order to standardize the diagnostic approach to GISTs and leiomyomas, we assigned scores for seven upper endoscopic and EUS features. Results The mean total scores in the GIST group were significantly higher than those in the leiomyoma group: 3.25 ± 1.71 and 0.53 ± 0.83 (p < 0.0001), respectively. Increment by one score increased the odds ratio for GIST 5.87 times (95% CI 1.63-21.11; p = 0.007). The total score demonstrated very good discriminatory features of GISTs against leiomyomas (area under the receiver operating characteristic curve 0.94 [0.86-1]). The cutoff value of 1.5 total score indicated 83.3% sensitivity and 93.3% specificity in diagnosing GISTs. Conclusions Upper endoscopy and EUS are useful methods in making a definite diagnosis of SELs. Their diagnostic accuracy for the differential diagnosis of GISTs and leiomyomas is sufficient.
Collapse
Affiliation(s)
- Rolandas Vaicekauskas
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Juozas Stanaitis
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Jonas Valantinas
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| |
Collapse
|
16
|
Kumar S, Chandrasekhara V, Kochman ML, Ahmad N, Attalla S, Ho IK, Jaffe DL, Lee PJ, Panganamamula KV, Saumoy M, Fortuna D, Ginsberg GG. Ligation-assisted endoscopic mucosal resection for esophageal granular cell tumors is safe and effective. Dis Esophagus 2020; 33:5843550. [PMID: 32448896 PMCID: PMC7397483 DOI: 10.1093/dote/doaa027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/16/2020] [Accepted: 04/01/2020] [Indexed: 12/11/2022]
Abstract
Given their malignant potential, resection of esophageal granular cell tumors (GCTs) is often undertaken, yet the optimal technique is unknown. We present a large series of dedicated endoscopic resection using band ligation (EMR-B) of esophageal GCTs. Patients diagnosed with esophageal GCTs between 2002 and 2019 were identified using a prospectively collected pathology database. Endoscopic reports were reviewed, and patients who underwent dedicated EMR-B of esophageal GCTs were included. Medical records were queried for demographics, findings, adverse events, and follow-up. We identified 21 patients who underwent dedicated EMR-B for previously identified esophageal GCT. Median age was 39 years; 16 (76%) were female. Eight (38%) had preceding signs or symptoms, potentially attributable to the GCT. Upon endoscopic evaluation, 12 (57%) were found in the distal esophagus. Endoscopic ultrasound was used in 15 cases (71%). Median lesion size was 7 mm, interquartile range 4 mm-8 mm. The largest lesion was 12 mm. A total of 20 (95%) had en bloc resection confirmed with pathologic examination. The only patient with tumor extending to the resection margin underwent surveillance endoscopy that showed no residual tumor. No patients experienced bleeding, perforation, or stricturing in our series. No patients have had known recurrence of their esophageal GCT. EMR-B of esophageal GCT achieves complete histopathologic resection with minimal adverse events. EMR-B is safe and effective and seems prudent compared with observation for what could be an aggressive and malignant tumor. EMR-B should be considered first-line therapy when resecting esophageal GCT up to 12 mm in diameter.
Collapse
Affiliation(s)
- Shria Kumar
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Address correspondence to: Dr Shria Kumar, MD, Division of Gastroenterology, Perelman Center for Advanced Medicine, South Pavilion, 7th Floor, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | | | - Michael L Kochman
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Nuzhat Ahmad
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sara Attalla
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Immanuel K Ho
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - David L Jaffe
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Peter J Lee
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Kashyap V Panganamamula
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Monica Saumoy
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Danielle Fortuna
- Division of Pathology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory G Ginsberg
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
17
|
Yin X, Yin Y, Liu X, Yang C, Chen X, Shen C, Chen Z, Zhang B, Cao D. Identification of gastrointestinal stromal tumors from leiomyomas in the esophagogastric junction: A single-center review of 136 cases. Medicine (Baltimore) 2020; 99:e19884. [PMID: 32332661 PMCID: PMC7220686 DOI: 10.1097/md.0000000000019884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
To identify significant clinical and CT features for the differentiation of gastrointestinal stromal tumors (GISTs) from leiomyomas in the esophagogastric junction (EGJ).One hundred thirty six patients with pathologically proven GISTs (n = 87) and leiomyomas (n = 49) in the EGJ were enrolled. And preoperative CT images were available in 73 GISTs cases and 34 leiomyoma cases. Two radiologists reviewed the CT images by consensus with regard to tumor size, shape, growth pattern, surface, enhancement pattern, enhancement degree, attention at each phasic image and the presence of surface ulcer, calcification, and intralesional low attention.Eight significant clinical and CT features were identified for differentiating GISTs from leiomyomas: older age (>46.5 years), tumor long diameter >4.5 cm, heterogeneous enhancement, high degree enhancement, mean CT attenuation >69.2 HU, presences of intralesional low attenuation and surface ulcer, absences of calcification (P < .05). On the receiver operating characteristic curve analysis, an optimal cutoff score of 3.5 was achieved for differentiating GISTs from leiomyomas with an AUC of 0.844 (sensitivity: 76.7%, specificity: 76.5%).older age (>46.5 years), tumor long diameter >4.5 cm, heterogeneous enhancement, high degree enhancement, mean CT attenuation >69.2 HU, presences of intralesional low attenuation and surface ulcer, absence of calcification are significant features highly suggestive of GISTs in differentiation from leiomyomas in the EGJ.
Collapse
Affiliation(s)
| | - Yuan Yin
- Department of Gastrointestinal Surgery
| | | | | | - Xin Chen
- Department of Gastrointestinal Surgery
| | | | | | - Bo Zhang
- Department of Gastrointestinal Surgery
| | - Dan Cao
- Department of Medical Oncology, Cancer Center, and the State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
18
|
Milito P, Asti E, Aiolfi A, Zanghi S, Siboni S, Bonavina L. Clinical Outcomes of Minimally Invasive Enucleation of Leiomyoma of the Esophagus and Esophagogastric Junction. J Gastrointest Surg 2020; 24:499-504. [PMID: 30941689 DOI: 10.1007/s11605-019-04210-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 03/11/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Minimally invasive enucleation is the treatment of choice in symptomatic patients with esophageal leiomyoma. Comprehensive long-term follow-up data are lacking. Aim of this study was to review the clinical outcomes of three procedures for enucleation of leiomyoma of the esophagus and esophagogastric junction. METHODS A single institution retrospective review was performed using a prospectively collected research database and individual medical records. Demographics, presenting symptoms, use of proton-pump inhibitors (PPI), tumor location and size, treatment modalities, and subjective and objective clinical outcomes were recorded. Barium swallow and upper gastrointestinal endoscopy were routinely performed during the follow-up. Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) and Short-Form 36 questionnaires were used to compare quality of life before and after treatment. RESULTS Between 2002 and 2017, 35 patients underwent minimally invasive leiomyoma enucleation through thoracoscopy (n = 15), laparoscopy (n = 15), and endoscopy (n = 5). The overall morbidity rate was 14.3% and there was no mortality. All patients had a minimum of 1-year follow-up. The median follow-up was 49 (IQR 54) months, and there were no recurrences of leiomyoma. At the latest follow-up, the SF-36 scores were unchanged compared to baseline. However, there was a higher incidence of reflux symptoms (p < 0.050) and PPI use (p < 0.050) after endoscopic treatment. CONCLUSIONS Minimally invasive enucleation is safe and effective and can be performed by a variety of approaches according to leiomyoma location and morphology. Overall, health-related quality of life outcomes of each procedure appear satisfactory, but PPI dependence was greater in the endoscopic group.
Collapse
Affiliation(s)
- Pamela Milito
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Emanuele Asti
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Alberto Aiolfi
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Simone Zanghi
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Stefano Siboni
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy. .,Divisione Universitaria di Chirurgia, IRCSS Policlinico San Donato, Piazza E. Malan 2, 20097 San Donato Milanese, Milan, Italy.
| |
Collapse
|
19
|
Park JW, Gong EJ, Seo M, Jun BG, Seo HI, Park JK, Han KH, Lee SJ, Kim YD, Jeong WJ, Cheon GJ. An Esophageal Squamous Cell Carcinoma with Lymph Node Metastasis Presenting as a Small Subepithelial Tumor. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2019. [DOI: 10.7704/kjhugr.2019.0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
20
|
Xu H, Li Y, Wang F, Wang W, Zhang L. Video-Assisted Thoracoscopic Surgery for Esophageal Leiomyoma: A Ten-Year Single-Institution Experience. J Laparoendosc Adv Surg Tech A 2018; 28:1105-1108. [PMID: 30067130 DOI: 10.1089/lap.2018.0412] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE This study was a 10-year single-institution experience with surgery for esophageal leiomyomas comparing a minimally invasive approach to thoracotomy. MATERIALS AND METHODS A retrospective review of patients who underwent resection of esophageal leiomyomas between 2008 and 2017 was conducted. Information on demographic features, symptoms, the operative approach, and complications was recorded. RESULTS Fifty-six patients were enrolled. Forty patients underwent an open surgical approach, and 16 patients were treated using thoracoscopy. There was no postoperative mortality or esophageal leakage. Five patients required the repair of a mucosal injury during resection. There were no statistically significant differences in operative time, blood loss, chest tube duration, or the length of postoperative stay between the video-assisted thoracoscopic surgery (VATS) group and the thoracotomy group. The mean tumor size in the thoracotomy group was larger than that in the VATS group (3.63 ± 2.15 versus 2.23 ± 1.30, P = .01). CONCLUSIONS Thoracoscopic enucleation is a safe and effective treatment for esophageal leiomyoma.
Collapse
Affiliation(s)
- Hao Xu
- Department of Thoracic Surgery, The Second Hospital Affiliated with Harbin Medical University , Harbin, China
| | - Yi Li
- Department of Thoracic Surgery, The Second Hospital Affiliated with Harbin Medical University , Harbin, China
| | - Fei Wang
- Department of Thoracic Surgery, The Second Hospital Affiliated with Harbin Medical University , Harbin, China
| | - Wei Wang
- Department of Thoracic Surgery, The Second Hospital Affiliated with Harbin Medical University , Harbin, China
| | - Linyou Zhang
- Department of Thoracic Surgery, The Second Hospital Affiliated with Harbin Medical University , Harbin, China
| |
Collapse
|
21
|
Kohli DR, Faigel DO. Esophageal leiomyomas: Making mole hills out of mole hills? Gastrointest Endosc 2018; 87:378-379. [PMID: 29406926 DOI: 10.1016/j.gie.2017.08.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 08/27/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Divyanshoo R Kohli
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Douglas O Faigel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| |
Collapse
|