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Nanjo K, Tsurumaru D, Hirakawa M, Nishimuta Y, Mimori K, Ishigami K. Esophageal lymphangioma: Endoscopic ultrasound, computed tomography, and magnetic resonance imaging appearance. Radiol Case Rep 2024; 19:4841-4844. [PMID: 39234015 PMCID: PMC11373046 DOI: 10.1016/j.radcr.2024.07.144] [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: 06/13/2024] [Revised: 07/23/2024] [Accepted: 07/24/2024] [Indexed: 09/06/2024] Open
Abstract
A case of esophageal lymphangioma in a 75-year-old man who complained of worsening dysphagia is presented. Endoscopic ultrasound showed an echogenic pattern of honeycomb or grid-like multiple microcysts within the submucosa. The sagittal image of computed tomography showed a thickened esophageal wall and fluid retention in the proximal esophageal lumen. Magnetic resonance imaging showed a high signal intensity mass with a septate-like internal structure on T2-weighted imaging and short tau inversion recovery. The tumor was completely resected by endoscopic submucosal dissection. Esophageal lymphangioma is a rare submucosal tumor that can be precisely diagnosed by CT and/or MRI.
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Affiliation(s)
- Katsuya Nanjo
- Department of Radiology, Kyushu University Beppu Hospital, Beppu-city, Oita, Japan
| | - Daisuke Tsurumaru
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuokas-city, Fukuoka, Japan
| | - Masakazu Hirakawa
- Department of Radiology, Kyushu University Beppu Hospital, Beppu-city, Oita, Japan
| | - Yusuke Nishimuta
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuokas-city, Fukuoka, Japan
| | - Koshi Mimori
- Department of Surgery, Kyushu University Beppu Hospital, Beppu-city, Oita, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuokas-city, Fukuoka, Japan
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Dong Z, Barraza G, Affolter KE, Witt BL, Jedrzkiewicz J. Distinguishing Gastrointestinal Leiomyomas From Muscularis Propria in Biopsy Specimens by Differential Expression of S100 Immunohistochemical Stain. Am J Clin Pathol 2023; 159:53-59. [PMID: 36367375 DOI: 10.1093/ajcp/aqac128] [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: 03/31/2022] [Accepted: 09/13/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Interpreting small biopsy specimens or fine-needle aspirations of gastrointestinal tract (GI) smooth muscle lesions may be challenging when the differential diagnosis includes leiomyoma vs muscularis propria (MP). We evaluated the utility of S100 staining in distinguishing GI leiomyomas from MP. METHODS A search was conducted in our laboratory information system for cases of leiomyomas arising within the GI tract (2004-2021). Site-matched controls containing MP were selected (2018-2020). Five high-power fields (hpf) were counted on S100 immunohistochemical stains by two pathologists in the resections and by three different blinded pathologists in the biopsy specimens and analyzed. RESULTS The median S100 count was 2.5/5 hpf in leiomyoma resection cases (n = 38), which was significantly lower than the median count of 548/5 hpf in MP (n = 19) with a P value of <.0001. The median S100 count in biopsy specimens (n = 16) was 1.2/5 hpf and within the expected range of 1 to 104/5 hpf (minimum-maximum value) established by the leiomyoma resections. S100 counts in the normal MP were significantly higher than those observed in leiomyomas (P < .001). CONCLUSIONS S100 staining can aid in distinguishing a leiomyoma from MP in the GI tract, which is especially helpful when evaluating cases with limited sampling.
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Affiliation(s)
- Zachary Dong
- Department of Pathology, University of Utah, Salt Lake City, UT, USAand
| | - Gonzalo Barraza
- Department of Pathology, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Kajsa E Affolter
- Department of Pathology, University of Utah, Salt Lake City, UT, USAand
| | - Benjamin L Witt
- Department of Pathology, University of Utah, Salt Lake City, UT, USAand
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Sharma NR, Linke CS, Zelt C. Endoscopic Mucosal Resection of Granular Cell Tumors in the Esophagus: a Study of Four Cases and Brief Literature Review. J Gastrointest Cancer 2019; 49:532-537. [PMID: 28477072 DOI: 10.1007/s12029-017-9947-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Neil R Sharma
- Parkview Cancer Institute, Advanced Interventional Endoscopy & Endoscopic Oncology, GI Oncology Program, 11104 Parkview Circle, Suite 310, Fort Wayne, IN, 46845, USA
| | - Colin S Linke
- Loyola University Medical Center, 2160 S 1st Ste 3312, Maywood, IL, 60153, USA
| | - Christina Zelt
- Parkview Research Center, 3602 New Vision Drive, Fort Wayne, IN, 46845, USA.
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Wong VWY, Goto O, Gregersen H, Chiu PWY. Endoscopic Treatment of Subepithelial Lesions of the Gastrointestinal Tract. ACTA ACUST UNITED AC 2017; 15:603-617. [DOI: 10.1007/s11938-017-0152-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Reimão SM, Colaiacovo R, Camunha MAR, Amancio TT, Segatelli V, Paulo GAD. Mediastinal tumor: not always a lymphoma. EINSTEIN-SAO PAULO 2017; 15:376-377. [PMID: 28746589 PMCID: PMC5823057 DOI: 10.1590/s1679-45082017ai3981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 04/13/2017] [Indexed: 11/23/2022] Open
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Baysal B, Masri OA, Eloubeidi MA, Senturk H. The role of EUS and EUS-guided FNA in the management of subepithelial lesions of the esophagus: A large, single-center experience. Endosc Ultrasound 2017; 6:308-316. [PMID: 26365993 PMCID: PMC5664851 DOI: 10.4103/2303-9027.155772] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Referral for endosonographic evaluation of subepithelial lesions seen in the gastrointestinal (GI) tract is fairly common. Although rarely studied separately in details, esophageal lesions have some unique differences from other GI sites and might deserve some special considerations regarding follow-up and management. MATERIALS AND METHODS All cases referred for endoscopic ultrasound (EUS) evaluation of subepithelial esophageal lesions at Bezmialem University Hospital, a tertiary center in Istanbul, Turkey were retrospectively reviewed. Data were collected for patient and lesion characteristics as well as for pathology results and follow-up if available. Lesions were subcategorized according to their size, location, and final diagnosis. RESULTS A total of 164 EUS examinations were identified. In 22.5% of cases, the lesion could not be identified by EUS. Of the remaining cases, 57.6% had a lesion larger than 1 cm in size. Extramural compression was the diagnosis in 12% and leiomyoma in around 60%. Thirteen patients had follow-up examinations with only two showing an increase in size after 12 months. Sixty-five EUS-guided fine needle aspirations (EUS-guided FNAs) were performed, with around 50% having nondiagnostic samples and 94% of the remaining samples confirming the presumptive diagnosis. CONCLUSIONS The majority of subepithelial lesions in the esophagus are benign with extremely low malignancy potential. EUS examinations performed for lesions smaller than 2 cm as well as FNAs taken from lesions smaller than 3 cm might have minimal impact on their ultimate management and outcome. More than one FNA pass should be attempted in order to improve the yield.
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Affiliation(s)
- Birol Baysal
- Department of Internal Medicine, Division of Gastroenterology, Bezmialem Vakif University Hospital, Istanbul, Turkey
| | - Omar A Masri
- Department of Internal Medicine, Division of Gastroenterology, Bezmialem Vakif University Hospital, Istanbul, Turkey
| | - Mohamad A Eloubeidi
- Department of Gastroenterology, Advanced Endoscopy Unit, Regional Medical Center, Alabama, USA
| | - Hakan Senturk
- Department of Internal Medicine, Division of Gastroenterology, Bezmialem Vakif University Hospital, Istanbul, Turkey
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Zhang Y, Sun X, Gold JS, Sun Q, Lv Y, Li Q, Huang Q. Heterotopic pancreas: a clinicopathological study of 184 cases from a single high-volume medical center in China. Hum Pathol 2016; 55:135-42. [PMID: 27195908 DOI: 10.1016/j.humpath.2016.05.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 04/18/2016] [Accepted: 05/05/2016] [Indexed: 12/18/2022]
Abstract
Heterotopic pancreas (HP) is often an incidental finding during operative or endoscopic procedures and described in case reports and small series in the literature. Large clinicopathological studies with a systematic analysis remain lacking. Herein, we identified 184 (0.18%; 184/99 544) consecutive histology-proven HP cases of 89 770 surgical resections and 9774 upper endoscopic biopsies carried out at a single medical center in China. Each case was diagnosed by unequivocal identification of pancreatic acini at a location outside the pancreas. The patients' median age was 49 years (range, 14-82) with a slight female predominance (male/female ratio, 0.94). Clinical presentation at diagnosis was nonspecific. Preoperatively, most (54.9%; 101/184) HP lesions were misdiagnosed. Only 26 HP lesions (14.1%) were correctly diagnosed, all in the stomach except for 1 in the duodenum; 57 (31%) were detected during operative procedures for other conditions. The most frequent location of HP was, in descending order, the stomach (97; 52.7%), small intestine (48; 26%), lesser and greater curvature omentum (18; 10%), spleen and hilar region (5; 2.7%), porta hepatis (2; 1%), gallbladder (1; 0.5%), peridistal esophageal tissue (4; 2.2%), and mesentery (7; 3.8%). The size of HP varied from smaller than 0.5 cm (35.3%), 0.6 to 1 cm (34.8%), to larger than 1.1 cm (29.9%). Because of difficulty in preoperative diagnosis, careful workup for upper gastrointestinal diseases with HP as a differential diagnosis may increase the chance of accurate diagnosis and appropriate patient management.
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Affiliation(s)
- Yifen Zhang
- Department of Pathology, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province 210008, China
| | - Xitai Sun
- Department of Laparoscopic Surgery, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province 210008, China
| | - Jason S Gold
- Department of Surgery, Veterans Affairs Boston Healthcare System and Harvard Medical School, West Roxbury, MA 02132
| | - Qi Sun
- Department of Pathology, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province 210008, China
| | - Ying Lv
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province 210008, China
| | - Qiang Li
- Department of Laparoscopic Surgery, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province 210008, China
| | - Qin Huang
- Department of Pathology, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province 210008, China; Department of Pathology and Laboratory Medicine, Veterans Affairs Boston Healthcare System and Harvard Medical School, West Roxbury, MA 02132.
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Abstract
Benign esophageal and paraesophageal masses and cysts are a rare but important group of pathologies. Although often asymptomatic, these lesions can cause a variety of symptoms and, in some cases, demonstrate variable biological behavior. Contemporary categorization relies heavily on endoscopic ultrasound and other imaging modalities and immunohistochemical analysis when appropriate. Minimally invasive options including endoscopic, laparoscopic, and thoracoscopic methods are increasingly used for symptomatic or indeterminate lesions.
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Affiliation(s)
- Cindy Ha
- Department of Surgery, Division of General Surgery at SIU, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62794, USA
| | - James Regan
- Department of Surgery, Division of General Surgery at SIU, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62794, USA
| | - Ibrahim Bulent Cetindag
- Department of Surgery, Division of General Surgery at SIU, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62794, USA
| | - Aman Ali
- Department of Internal Medicine, Division of Gastroenterology, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62794, USA
| | - John D Mellinger
- Department of Surgery, Division of General Surgery at SIU, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62794, USA.
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Kobara H, Mori H, Rafiq K, Fujihara S, Nishiyama N, Ayaki M, Yachida T, Tani J, Miyoshi H, Kamada H, Morishita A, Oryu M, Tsutsui K, Haba R, Masaki T. Indications of endoscopic submucosal dissection for symptomatic benign gastrointestinal subepithelial or carcinoid tumors originating in the submucosa. Mol Clin Oncol 2013; 1:1002-1008. [PMID: 24649284 DOI: 10.3892/mco.2013.177] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 08/19/2013] [Indexed: 02/06/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) for upper gastrointestinal (GI) subepithelial tumors (SETs) originating in the muscularis propria (MP) layer is associated with numerous issues regarding secure closure and measures against accidental perforation. However, symptomatic benign GI SETs or carcinoid tumors originating in the submucosa (SM) may be safely resected en-bloc using ESD. In this study, the feasibility and safety of ESD as a novel method for endoscopic resection for such GI SETs revealed on endoscopic ultrasonography (EUS) was investigated. A total of 12 consecutive cases of patients with symptomatic benign SETs (n=3; 1 esophageal hemangioma and 2 gastric lipomas) or small carcinoid tumors (n=9; <10 mm, with an extremely low risk of metastasis) originating in the SM as determined on EUS, between March, 2009 and April, 2013, were retrospectively reviewed. The lesions were resected by ESD after confirming that the tumors originated from the SM. The complication rate following en-bloc resection was also determined. En-bloc resection was achieved in all 12 cases, the mean procedure time was 45 min (range, 20-120 min) and no complications occurred intra- or postoperatively. There was no tumor recurrence or disease-related mortality reported during the follow-up period (median follow-up time, 13.4 months). Histopathological curative resection was achieved with ESD without complications in all 9 cases with carcinoid tumors. Therefore, if EUS reveals a SET originating in the SM without infiltration of the MP and resection is indicated due to the presence of abdominal symptoms, ESD may be a feasible option for diagnostic treatment with minimal invasiveness. However, larger-scale prospective studies are required to establish the feasibility and safety of this procedure.
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Affiliation(s)
- Hideki Kobara
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
| | - Hirohito Mori
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
| | - Kazi Rafiq
- Pharmacology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
| | - Shintarou Fujihara
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
| | - Noriko Nishiyama
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
| | - Maki Ayaki
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
| | - Tatsuo Yachida
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
| | - Johji Tani
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
| | - Hisaaki Miyoshi
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
| | - Hideki Kamada
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
| | - Asahiro Morishita
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
| | - Makoto Oryu
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
| | - Kunihiko Tsutsui
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
| | - Reiji Haba
- Diagnostic Pathology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
| | - Tsutomu Masaki
- Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Miki, Kagawa 7610793, Japan
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Lee KJ, Kim GH, Park DY, Shin NR, Lee BE, Ryu DY, Kim DU, Song GA. Endoscopic resection of gastrointestinal lipomas: a single-center experience. Surg Endosc 2013; 28:185-92. [PMID: 23996333 DOI: 10.1007/s00464-013-3151-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 07/22/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gastrointestinal (GI) lipomas are benign, slow-growing subepithelial tumors. Most lipomas are detected incidentally at endoscopy, but they can cause GI bleeding, abdominal pain, intestinal obstruction, and intussusception, particularly if they are larger than 2 cm in diameter. The aim of this study was to investigate the efficacy, safety, and long-term prognosis of endoscopic treatment of GI lipomas. METHODS A total of 28 GI lipomas treated endoscopically from January 2005 to June 2012 were retrospectively reviewed. Endoscopic treatment was performed by four methods: the unroofing technique, endoscopic mucosal resection (EMR), EMR after precutting (EMR-P), and endoscopic submucosal dissection (ESD). RESULTS Of 28 GI lipomas, 5 were located in the stomach, 2 in the duodenum, and 21 in the colon. Thirteen lipomas were <2 cm in diameter (small lipoma), and the other 15 were ≥2 cm (large lipoma). The unroofing technique was performed in 2 cases, EMR in 17 cases, EMR-P in 4 cases, and ESD in 5 cases. En bloc resection was performed with 21 lesions (75 %), and endoscopic complete resection was achieved with 26 lesions (93 %). Incomplete resection occurred in the 2 cases treated by the unroofing technique. On pathologic examination, complete resection was achieved with 21 lesions (75 %). Delayed bleeding was observed in one patient. There were no serious complications such as perforation or post-procedural stricture. During the mean follow-up period of 19 months (range 2-91 months), no recurrence was observed. CONCLUSIONS Endoscopic treatment appears to be a safe and effective treatment for GI lipomas, including large lipomas (≥2 cm in diameter).
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Affiliation(s)
- Kwang Jae Lee
- Department of Internal Medicine, Pusan National University School of Medicine, 1-10, Ami-dong, Seo-gu, Pusan, 602-739, Korea
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Kahng DH, Kim GH, Park DY, Jeon MS, Yi JW, Choi YY, Song GA. Endoscopic resection of granular cell tumors in the gastrointestinal tract: a single center experience. Surg Endosc 2013; 27:3228-36. [PMID: 23479255 DOI: 10.1007/s00464-013-2899-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 02/15/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND The frequency of granular cell tumors (GCTs) identified in the gastrointestinal tract has recently increased with the increased use of routine endoscopy. Endoscopic treatment is increasingly used as an alternative to traditional surgical resection, but there are few reports on the efficacy, safety, and long-term prognosis of endoscopic treatment for GCTs. The aim of this study was to assess the efficacy, safety, and long-term prognosis of endoscopic resection for the gastrointestinal GCTs. METHODS We examined a total of 27 GCTs in 25 patients who were treated by endoscopic resection from January 2007 to February 2011. For endoscopic resection, endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) was used. RESULTS Twenty GCTs were located in the esophagus, 5 in the stomach, and 2 in the colon. The median size of the GCTs was 10 mm; the largest size, located in the ascending colon, measured 18 mm. EMR with a ligation device was performed in 20 cases, conventional EMR in 5 cases, and ESD in 2 cases. En bloc resection was performed in 25 cases (92.6%), and endoscopic complete resection piecemeal resection was achieved in 25 cases (92.6%). Pathologic complete resection was achieved in 22 lesions (81.5%). Intraprocedural bleeding was noted in three patients, with no occurrence of perforation or postprocedure stricture. No recurrence was observed during the mean follow-up period of 15 months (range 9-31 months). CONCLUSIONS Endoscopic resection appears to be a safe and effective treatment for GCTs in the gastrointestinal tract.
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Affiliation(s)
- Dong Hwahn Kahng
- Department of Internal Medicine, Pusan National University School of Medicine, 1-10 Ami-dong, Seo-Gu, Pusan 602-739, Korea
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Consensus of the present and prospects on endoscopic diagnosis and treatment in East asian countries. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2012; 2012:808365. [PMID: 23093833 PMCID: PMC3474969 DOI: 10.1155/2012/808365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 08/28/2012] [Indexed: 11/18/2022]
Abstract
Background and Aim. New diagnostic or therapeutic methods in endoscopy have been used. Current clinical application of these procedures is not well known. The aim of this study is to investigate the present situation on endoscopic diagnosis and treatment of gastrointestinal disorders in East Asian countries. Method. A representative member from the International Gastrointestinal Consensus Symposium Committee provided a questionnaire to physicians in China, Indonesia, Japan, Korea, the Philippines, and Thailand. Results. In total, 514 physicians including gastroenterologists, surgeons, and general practitioners enrolled. The most frequently occurring disorder as the origin of upper gastrointestinal bleeding is gastric ulcer. Capsule endoscopy is selected as the first choice for the diagnosis of small intestine bleeding. The second choice was double-balloon endoscopy or angiography. For patients with gastric adenoma, the number of physicians who choose endoscopic mucosal resection is larger than those selecting endoscopic submucosal dissection (ESD) in China, Indonesia, the Philippines, and Thailand. ESD is chosen first in Japan and Korea. Conclusion. New instruments or techniques on endoscopy have not come into wide use yet, and there is diversity in the situation on it in Asian countries. We should unify the endoscopic diagnostic criteria or treated strategy in patients with GI disease.
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Choi HS, Chun HJ, Keum B, Jeen YT. The indications for endoscopic resection of esophageal submucosal tumor. Gastrointest Endosc 2012; 76:225-6; author reply 226. [PMID: 22726490 DOI: 10.1016/j.gie.2012.01.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 01/31/2012] [Indexed: 01/31/2023]
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Response. Gastrointest Endosc 2012. [DOI: 10.1016/j.gie.2012.02.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
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15
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Liu BR, Song JT, Qu B, Wen JF, Yin JB, Liu W. Endoscopic muscularis dissection for upper gastrointestinal subepithelial tumors originating from the muscularis propria. Surg Endosc 2012; 26:3141-8. [PMID: 22580875 DOI: 10.1007/s00464-012-2305-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Accepted: 04/02/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Based on our experience with endoscopic submucosal dissection (ESD) and new endoscopic techniques for endoscopic closure of iatrogenic upper gastrointestinal (upper-GI) perforations, we developed methods to remove upper-GI subepithelial tumors (SETs) originating from the muscularis propria by endoscopic muscularis dissection (EMD). The aim of this study is to evaluate the clinical feasibility and safety of EMD. METHODS 31 patients with upper-GI SETs originating from the muscularis propria were treated by EMD. The EMD differed from ESD in (1) precutting the overlying mucosa above the lesion by using snare or longitudinal incision instead of circumferential incision, (2) dissecting the complete tumors away from submucosal and muscularis propria tissue by electrical dissection combined with blunt dissection, and (3) closing the wound with clips. Perforations occurring during dissection were closed by endoscopic methods. RESULTS 30 of 31 tumors were resected completely (96.8 %). One esophageal lesion was resected partially because of severe adhesions with surrounding tissue. Mean resected tumor size was 22.1 mm × 15.5 mm, and mean operation time was 76.8 min (range 15-330 min). Histological diagnosis was gastrointestinal stromal tumor (GIST) in 16 lesions [6 esophageal, 3 cardial, 7 gastric; 6 very low risk and 10 low risk according to the National Institutes of Health (NIH) risk classification] and leiomyoma in 15 lesions (8 esophageal, 4 cardial, 3 gastric). No patient developed delayed hemorrhage. Perforation occurred in four patients (12.9 %), all of which were managed successfully by endoscopic techniques. The mean follow-up time was 17.7 months (range 7-35 months). Follow-up found no tumor recurrence in any patient. CONCLUSIONS In this early experience, EMD appears to be a feasible and minimally invasive treatment for some patients with upper-GI SETs originating from the muscularis propria. Although there is a higher risk of perforation than with ESD, this will improve with extended practice, and perforations have become manageable endoscopically.
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Affiliation(s)
- Bing-Rong Liu
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Nangang District, Harbin, 150086, People's Republic of China.
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Zhong N, Katzka DA, Smyrk TC, Wang KK, Topazian M. Endoscopic diagnosis and resection of esophageal granular cell tumors. Dis Esophagus 2011; 24:538-43. [PMID: 21539675 DOI: 10.1111/j.1442-2050.2011.01197.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Granular cell tumors (GCT) are uncommon neoplasms. There is controversy regarding the endoscopic diagnosis and treatment of esophageal GCT. We studied the endoscopic diagnosis and management of esophageal GCT among 23 patients identified in a single-institution pathology database. Medical records, pathology, and endoscopic images were reviewed. All patients underwent endoscopy and endoscopic ultrasonography (EUS), and endoscopic resection was performed in 10 patients. Seven of 23 patients had more than one esophageal GCT. Only six lesions exhibited a classic yellow discoloration. Among patients with a single GCT, three, four, and nine lesions were located in the proximal, middle, and distal esophagus, respectively. EUS showed hypoechoic, smooth-edged lesions usually confined to deep mucosa and submucosa. Standard forceps biopsy was diagnostic in 19 of 23 patients (83%). Ten GCT ≤ 10 mm in diameter underwent successful endoscopic mucosal resection without complication. The endoscopic appearance, location, and number of esophageal GCT are highly variable. Histological proof is still necessary for the differential diagnosis of this rare neoplasm. Endoscopic forceps biopsy is usually diagnostic. Endoscopic resection appears safe and effective in selected cases with lesions ≤ 10 mm.
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Affiliation(s)
- N Zhong
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, 200 First Street SW, Mayo Clinic, Rochester, MN 55905, USA
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Díaz-Sánchez A, Soto S, Ponferrada A, Campos R, García MO, Benito DM, Troya J, Merino B, Aldeguer M. [Granular cell tumor of the esophagus: description of an infrequent benign tumor]. GASTROENTEROLOGIA Y HEPATOLOGIA 2011; 34:454-9. [PMID: 21636174 DOI: 10.1016/j.gastrohep.2011.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 03/01/2011] [Accepted: 03/02/2011] [Indexed: 02/08/2023]
Abstract
Granular cell tumors (GCT) are infrequent tumors first described by Abrikossoff in 1926. Gastrointestinal involvement occurs in about 6% of GCT, the esophagus being the most frequent location. These tumors are usually benign and asymptomatic and are usually found incidentally when an upper gastrointestinal endoscopy is carried out for another reason, showing an isolated polyp or sessile submucosal nodule, covered by intact yellowish mucosa and with firm consistency. Endoscopic ultrasonography has significantly improved the diagnosis of these lesions. Nowadays endoscopic mucosectomy is the treatment of choice of esophageal GCT with a low frequency of complications. Histologic analysis of the surgical specimen shows specific characteristics such as positivity for S-100 protein. We present two new cases of esophageal GCT that were diagnosed recently and discuss the most relevant features of this infrequent disease.
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Affiliation(s)
- Antonio Díaz-Sánchez
- Sección de Aparato Digestivo, Hospital Universitario Infanta Leonor, Madrid, España.
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18
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Walz B, von Renteln D, Schmidt A, Caca K. Endoscopic full-thickness resection of subepithelial tumors with the use of resorbable sutures (with video). Gastrointest Endosc 2011; 73:1288-91. [PMID: 21481864 DOI: 10.1016/j.gie.2011.01.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 01/24/2011] [Indexed: 02/08/2023]
Affiliation(s)
- Bastian Walz
- Department of Gastroenterology, Hepatology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
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19
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Abstract
PURPOSE OF REVIEW To summarize the literature to date on endoscopic mucosal removal techniques as applied to the upper gastrointestinal tract, predominantly the stomach and esophagus. This is an area that has rapidly advanced in terms of new procedures and techniques with a large body of outcomes that support their use. RECENT FINDINGS The resection techniques can be divided into two forms, mucosal resection and submucosal dissection. Mucosal resection is typically done with cap techniques and is more suitable for removable of neoplastic lesions that are less than 1.5 cm in size. Submucosal dissection techniques are more difficult, associated with increased complications, and typically reserved for lesions greater than 1.5 cm and less than 3 cm in size. Ideal lesions for mucosal resection are generally flat and are located in areas easily accessible by the endoscope. SUMMARY Endoscopic tissue removal methods are capable of removing neoplastic lesions en bloc in the upper gastrointestinal tract. These techniques fulfill cancer treatment guidelines by having histological confirmation of total removal of neoplastic lesions with assessment of the margins of resections. Long-term clinical outcomes of these techniques are emerging and seem promising in terms of disease-free and overall survival.
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Kim JH, Lim JS, Lee YC, Hyung WJ, Lee JH, Kim MJ, Chung JB. Endosonographic features of gastric ectopic pancreases distinguishable from mesenchymal tumors. J Gastroenterol Hepatol 2008; 23:e301-7. [PMID: 18522684 DOI: 10.1111/j.1440-1746.2008.05351.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Gastric ectopic pancreas is the second common submucosal lesion in the stomach, and differs from mesenchymal tumors with respect to clinical approach and prognosis. The purpose of our study was to evaluate the endoscopic ultrasound (EUS) findings for differentiating between gastric ectopic pancreases and mesenchymal tumors. METHODS All patients (n = 71) were diagnosed pathologically as having gastric ectopic pancreas (n = 18) or mesenchymal tumors (n = 53) between 2002 and 2006. The EUS images of the patients were retrospectively reviewed by two observers who were unaware of the pathological results, regarding location, size, growth pattern, layer of origin, presence or absence of layer disruption, margin, and internal echo pattern. These EUS imaging findings were compared for ectopic pancreases and mesenchymal tumors. RESULTS Compared with mesenchymal tumors, ectopic pancreases showed a significant difference in the lesion location, growth pattern, layer of origin, presence of layer disruption, margin, and internal echo (P < 0.05). The longest/shortest diameter ratio was also larger in ectopic pancreases (p < 0.05). There was no statistical difference in the lesion size and presence of focal anechoic portion. CONCLUSION Careful assessment of the EUS findings may be a useful aid in the differentiation of ectopic pancreases from mesenchymal tumors in the stomach.
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Affiliation(s)
- Jie-Hyun Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of medicine, Seoul, Korea
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21
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Benign Esophageal Tumors. POLISH JOURNAL OF SURGERY 2008. [DOI: 10.2478/v10035-007-0127-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kent M, d'Amato T, Nordman C, Schuchert M, Landreneau R, Alvelo-Rivera M, Luketich J. Minimally invasive resection of benign esophageal tumors. J Thorac Cardiovasc Surg 2007; 134:176-81. [PMID: 17599505 DOI: 10.1016/j.jtcvs.2006.10.082] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Revised: 10/02/2006] [Accepted: 10/09/2006] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Benign tumors of the esophagus are uncommon. Traditionally, resection has required thoracotomy or laparotomy. In this study we present our experience with resection of these tumors using a minimally invasive approach. METHODS A retrospective review of patients who underwent resection of benign esophageal tumors between 1990 and 2005 was conducted. Operative approach, tumor size, and outcomes after surgery were recorded. RESULTS Twenty patients were identified (leiomyoma: n = 15; stromal tumor: n = 3; granular cell tumor, n = 1; schwannoma: n = 1). Four patients underwent an open approach (right thoracotomy); the remainder were resected using minimally invasive techniques (thoracoscopy, n = 9; laparoscopy, n =7). There were no postoperative leaks or other major complications after surgery. Two patients required repair of a mucosal injury during resection. Mean tumor size in the open group was 8.1 cm (range 7-10 cm) compared with 3.5 cm (range 0.9-8 cm) in the minimally invasive group. Median length of stay was 5.5 days in the open group compared with 2.75 days in the minimally invasive group. Five patients subsequently required fundoplication for worsening (n = 3) or new-onset (n = 2) gastroesophageal reflux disease after tumor resection. CONCLUSIONS Minimally invasive resection of benign esophageal tumors is technically safe and associated with a shorter length of stay compared with open approaches. Although no specific cutoff for size could be identified, most tumors greater than 7 cm were removed by thoracotomy. The subsequent development of reflux may be related to the esophageal myotomy required for resection.
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Affiliation(s)
- Michael Kent
- University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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Martínez-Ares D, Martínez Cadilla J, Cáceres Alvarado N, González Carreró-Fojón J, Martín-Granizo Barrenechea I, Pallarés Peral A. Tumor estromal gástrico de riesgo intermedio: diagnóstico mediante ecografía hidrogástrica. GASTROENTEROLOGIA Y HEPATOLOGIA 2006; 29:622-4. [PMID: 17198640 DOI: 10.1157/13095197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Evaluation of submucosal lesions of the digestive tract with conventional endoscopy is unsatisfactory since this technique does not allow direct observation or correct evaluation of the size and layer of origin of the tumor; therefore, in most patients an etiological diagnosis cannot be established with this procedure. However, in most patients, endoscopic ultrasonography can resolve these problems: to a fair degree of certainty, this technique can differentiate malignant from benign lesions, measure their size, and establish their layer of origin. Endoscopic ultrasonography is the technique of choice to establish the presence and characteristics of submucosal tumors and their suitability for treatment. Moreover, this procedure can identify tumors that can be removed endoscopically without excessive risk. Hydrogastric ultrasonography can be an effective substitute for echoendoscopy when evaluating submucosal lesions and for staging tumors of the gastric antrum when echoendoscopy is not available or in patients in whom it cannot be performed. Hydrogastric ultrasonography is safe, inexpensive and very well tolerated by patients. We present the case of a female patient with a gastric GIST that was evaluated using hydrogastric ultrasonography. The size, layer of origin, and malignancy of the tumor were accurately established.
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Affiliation(s)
- David Martínez-Ares
- Servicio de Digestivo, Complejo Hospitalario Universitario Xeral-Cíes, Vigo, Pontevedra, España.
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Yu HG, Ding YM, Tan S, Luo HS, Yu JP. A safe and efficient strategy for endoscopic resection of large, gastrointestinal lipoma. Surg Endosc 2006; 21:265-9. [PMID: 17122972 DOI: 10.1007/s00464-006-0059-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Accepted: 04/27/2006] [Indexed: 12/18/2022]
Abstract
BACKGROUND Gastrointestinal (GI) lipomas are benign, slowly growing, submucosal tumors, which may cause gastrointestinal bleeding, anemia, intussusception, and bowel obstruction. The aim of this study is to explore the safe and effective strategy for endoscopic removal of large GI lipomas. METHODS During last 10 years, fifteen large and symptomatic GI lipomas were resected under endoscopy in our hospital. In them, two large lipomas with small stalk (< 2 m in diameter) were resected by polypectomy; ten large lipomas with base size greater than 2 cm in diameter were removed using a "subtotal resection." Three other large lipomas with small stalk (< 2 m in diameter) were resected by multistep resection. Endoscopic ultrasonography (EUS) and miniprobe endoscopic ultrasound were performed in six cases from January 2000 to July 2004 to confirm that those lesions were lipomas that were superficial to the muscularis propria. RESULTS All 15 lesions were successfully removed and were histopathologically confirmed to be lipomas. No severe complications, such as perforation or hemorrhage, developed after endoscopic removal. No recurrence was observed after 1-8 years follow-up endoscopic examination. CONCLUSIONS Various, large GI lipomas can be removed safely by electrosurgical snare resection under endoscopy following the guidance of the present therapeutic strategy.
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Affiliation(s)
- H-G Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Jiefang Road 238, 430060, Wuhan, People's Republic of China.
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Rampado S, Battaglia G, Ruol A, Parenti A, Portale G, Bocus P, Ancona E. Endoscopic treatment of pseudosarcomatous squamous carcinoma of the esophagus: case report and personal experience. Dis Esophagus 2006; 19:305-10. [PMID: 16866866 DOI: 10.1111/j.1442-2050.2006.00583.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Spindle cell (or pseudosarcomatous) squamous carcinoma (PSC) is a rare malignant neoplasm of the esophagus, potentially capable of causing lymph node and distant metastases. Indications for surgery are the same as for squamous cell carcinoma (SCC) of the esophagus. The aims of this paper were to report a case of endoscopically treated PSC and to review our experience of surgically-treated patients with PSC in order to identify patients potentially suitable for endoscopic treatment. In our series of 4,460 patients with carcinoma of the esophagus observed between 1980 and 2003, 28 (0.6%) had the histological features of PSC. One had a PSC histologically confirmed (8cm-long polyp with a 3cm-large base) and endoscopically treated for high surgical risk. The patient had a close follow-up with endoscopic biopsies and ultrasonography with no local recurrence at 3 years. The overall survival rate was 22% for PSC and 17% for SCC (P = n.s.); after 5 years, the survival rates were 22% and 13%, respectively (P = n.s.). In our opinion the limited tendency to parietal infiltration and the good chance of disclosure in an early stage with endoscopic ultrasonography, justify non-surgical solutions in patients with a high surgical risk, possibly associated with adjuvant chemo- and radiotherapy since lymph node involvement is reported in 50% of cases. The limited number of patients with PSC involved in the present series prevent any significant statistical comparisons between the different groups, but the survival rates were roughly the same in the nonsurgical curative therapy as in the curative resection group, while the chances of survival were significantly lower in patients given palliative surgery and or non-curative treatments (P < 0.05).
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Affiliation(s)
- S Rampado
- Department of Medical and Surgical Sciences, Clinica Chirurgica III, Padova, Italy
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Cantor MJ, Davila RE, Faigel DO. Yield of tissue sampling for subepithelial lesions evaluated by EUS: a comparison between forceps biopsies and endoscopic submucosal resection. Gastrointest Endosc 2006; 64:29-34. [PMID: 16813799 DOI: 10.1016/j.gie.2006.02.027] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2005] [Accepted: 02/03/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND In most circumstances, subepithelial tumors lack distinct endoscopic and ultrasonographic features. Consequently, definitive diagnosis usually requires tissue acquisition and pathologic confirmation. Establishing a tissue diagnosis is difficult because the yield of forceps biopsies is low. However, prospective data evaluating tissue sampling techniques for subepithelial lesions are currently lacking. OBJECTIVE Our purpose was to prospectively determine the diagnostic yield of endoscopic submucosal-mucosal resection (ESMR) compared with forceps biopsy for lesions limited to the submucosa (third endosonographic layer) of the GI tract. DESIGN A prospective head-to-head comparison was performed. SETTING The study was performed in a tertiary care hospital. PATIENTS Study patients were 23 adults with subepithelial lesions limited to the submucosa. INTERVENTION All submucosal lesions underwent forceps biopsy followed by endoscopic submucosal resection. Biopsy specimens were obtained with large-capacity "jumbo" forceps. A total of 4 double passes (8 biopsy specimens) were collected from each lesion with use of the bite-on-bite technique. Endoscopic resection was then performed with an electrosurgical snare or cap-fitted endoscopic mucosal resection device. MAIN OUTCOME MEASUREMENT The main outcome measurement was the diagnostic yield of biopsy forceps compared with endoscopic submucosal resection. RESULTS Twenty-three patients with lesions limited to the submucosa were identified by endoscopic ultrasonography. All lesions underwent forceps biopsy followed by ESMR. The diagnostic yield of the jumbo forceps biopsy was 4 of 23 (17%), whereas the diagnostic yield of ESMR was 20 of 23 (87%) (P = .0001, McNemar test). CONCLUSION In the evaluation of subepithelial lesions limited to the submucosa, ESMR has a significantly higher diagnostic yield than jumbo forceps biopsy with use of the bite-on-bite technique.
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Affiliation(s)
- Michael J Cantor
- Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA
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27
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Hwang JH, Rulyak SD, Kimmey MB. American Gastroenterological Association Institute technical review on the management of gastric subepithelial masses. Gastroenterology 2006; 130:2217-28. [PMID: 16762644 DOI: 10.1053/j.gastro.2006.04.033] [Citation(s) in RCA: 194] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This literature review and the recommendations therein were prepared for the American Gastroenterological Association Institute Clinical Practice and Economics Committee. The paper was approved by the Committee on January 19, 2006, and by the AGA Institute Governing Board on April 20, 2006.
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Affiliation(s)
- Joo Ha Hwang
- Division of Gastroenterology, University of Washington, Seattle, Washington, USA
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28
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Abstract
Endoscopic mucosal resection (EMR) is a promising therapeutic option for removal of superficial carcinomas or premalignant lesions throughout the gastrointestinal tract. This review discusses indications and the several techniques of EMR in early tumors of esophagus, stomach, duodenum, and colon. EMR is not yet widely utilized in the West. However, great benefits may be obtained from this non-invasive technique after an accurate evaluation of patients and a careful staging of lesions that may assess the depth of infiltration and exclude the presence of lymph node metastases. EMR permits a complete removal of the lesion with histologic assessment of the entire specimen and the change in the pathologic stage in a significant number of patients. To minimize the risk of serious complications (mostly bleeding and perforation), only experienced endoscopists should undertake EMR in an appropriate environment. Data from literature are encouraging on the use of EMR, but a long-term follow-up of a large number of patients is necessary to confirm the effectiveness of this therapy.
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Martínez-Ares D, Lorenzo MJV, Souto-Ruzo J, Pérez JCE, López JY, Belando RA, Vilas JD, Colell JMM, Iglesias JLV. Endoscopic resection of gastrointestinal submucosal tumors assisted by endoscopic ultrasonography. Surg Endosc 2005; 19:854-8. [PMID: 15868257 DOI: 10.1007/s00464-004-9123-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2004] [Accepted: 10/01/2004] [Indexed: 12/17/2022]
Abstract
BACKGROUND The resection and histologic examination of the lesions is generally considered the treatment of choice in order to achieve diagnosis in gastrointestinal submucosal tumors. Moreover, the degree of malignancy of the tumor depends on certain features that can only be studied on the entire resected piece. METHODS We revised the cases of patients who underwent endoscopic resection of gastrointestinal submucosal tumors in the period from 1997 through 2002. RESULTS Fifty submucosal lesions were resected in 45 patients (64.4% men). Patient mean age was 55.31 years. Of the lesions, 52% were gastric tumors and 88% were located in the second layer. Mean size was 12.34 mm, and 54% were smaller than 10 mm. Resection with submucosal injection of saline solution and diluted adrenaline was performed on 46% of the lesions, and standard resection using polypectomy snare on 48%. Ligation was used in three cases. Resection was successful in 98% and major complications were observed in 4% (two cases of bleeding, endoscopically resolved). CONCLUSIONS The endoscopic resection of submucosal tumors is a safe and efficient technique: It has few associated complications and allows diagnosis in all the cases and cure of the lesion in the great majority of cases.
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Affiliation(s)
- D Martínez-Ares
- Department of Gastroenterology, Complejo Hospitalario Universitario Juan Canalejo-A Coruña, Spain.
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Abstract
Endoscopic mucosal resection is an invaluable tool to diagnose and potentially treat superficial cancers in Barrett's esophagus as well as squamous cell cancers. The technique can be performed using equipment available in most endoscopic laboratories. The tissue retrieved from these procedures gives the endoscopist histologic information regarding tumor depth of penetration, which is critical to treatment of early cancers. In addition, standard pinch biopsies are often unable to diagnose malignancies that may underlie areas of dysplasia or even normal mucosa. Endoscopic mucosal resection can be used to diagnose these lesions with relative safety, particularly when applied to the esophagus.
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Affiliation(s)
- Granapathy Prasad
- Barrett’s Esophagus Unit, Division of Gastroenterology and Hepatology, 200 First Street SW, Mayo Clinic and Foundation, Rochester, MN 55905, USA
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Abstract
Most of the submucosal lesions encountered on endoscopy are benign; however, the fact that some of them may be malignant considerably influences the attitude toward the whole group. This article reviews the current status of endosonography in the management of submucosal lesions and focuses on determining the risk of malignancy. The predictive value of various endoscopic ultrasonography (EUS) features and their combinations and the capabilities and limitations of EUS-guided fine needle biopsy are discussed. Other issues addressed include differentiation between extraluminal compressions and true submucosal lesions, EUS-assisted endoscopic removal of submucosal lesions, and the potential role of catheter-based endosonography in the setting of submucosal lesions. Problems related to the surveillance of patients with submucosal lesions who are not candidates for surgical treatment are outlined. An overview of the recent changes in the pathologic classification of gastrointestinal mesenchymal tumors and their impact on the role of EUS in the management of submucosal lesions is given.
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Affiliation(s)
- Marcin Polkowski
- Department of Gastroenterology, Medical Center for Postgraduate Education, Institute of Oncology, Roentgena 5, 02-781 Warsaw, Poland.
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D'Errico A, Corti B, Fiorentino M, Di Simone M, Mattioli S, Grigioni WF. Endoscopic finding of granular cell tumour associated with leiomyomas in the oesophagus. Dig Liver Dis 2004; 36:292-5. [PMID: 15115343 DOI: 10.1016/j.dld.2003.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Following a single report in the literature of granular cell tumour associated with diffuse leiomyomatosis in the oesophagus, we describe the case of a 39-year-old man in whom a granular cell tumour and two leiomyomas were endoscopically removed from this site. This previously unreported association of granular cell tumour with isolated leiomyomas suggests the need to bear in mind the possibility of other mesenchymal lesions, including leiomyomas or leiomyomatosis, when a granular cell tumour is found in the oesophagus.
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Affiliation(s)
- A D'Errico
- Department of Oncology and Haematology, Pathology Division of the "Felice Addarii " Institute, Bologna University School of Medicine, Bologna, Italy
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Kim TI, Park YS, Choi EH, Park SW, Chung JB, Kang JK, Song SY. Endoscopic resection of a large leiomyoma of the esophagus. Gastrointest Endosc 2004; 59:129-33. [PMID: 14722568 DOI: 10.1016/s0016-5107(03)02279-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Tae Il Kim
- Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
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Affiliation(s)
- Joo Ha Hwang
- Division of Gastroenterology, University of Washington, Seattle, Washington 98195, USA
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35
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Abstract
Gastrointestinal endoscopy has changed in recent years from a largely diagnostic to a highly therapeutic procedure. Technical advances in endoscopic ultrasound as well as new devices designed for endoscopic mucosal resection (EMR) have opened the field to many therapeutic possibilities. Endoscopic resection is technically challenging, and while our colleagues in the Far East have been using such techniques for over a decade, EMR in the West is still in its infancy. The decision to resect a benign esophageal tumor must take several factors into account including whether the patient is symptomatic; characteristics of the particular tumor (including the potential for malignant transformation, risk of bleeding, and obstruction); and the available therapeutic options. Endoscopic resection of benign esophageal tumors is an attractive option as it is a safe and minimally invasive procedure. Its use is limited, however, to smaller tumors arising from the mucosal or submucosal layers. In this article we examine the techniques used in endoscopic mucosal resection and review the literature on this subject.
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Affiliation(s)
- Timothy Kinney
- Section of Endoscopy and Therapeutics, University of Chicago, Chicago, IL 60637, USA
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36
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Winkler T, Sulzbacher* I, Wrba* F, Bischof G, Wenzl E. Abrikossoff-Tumore im Gastrointestinaltrakt: Eigene Erfahrungen und Literaturubersicht. Eur Surg 2001. [DOI: 10.1046/j.1563-2563.2001.01174.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Endoscopic mucosal resection (EMR), or mucosectomy technique, developed by Japanese endoscopists consists of resecting flat and polypoid neoplasms of the mucosa by longitudinal section through the submucosa. This technique is relatively simple and carries a low morbidity. It represents an important advance for endoscopists in both technical and cancer areas. Compared with the endoscopic methods of tumor destruction (laser, plasma coagulation), EMR presents the advantage of obtaining a complete specimen for histologic analysis.
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Affiliation(s)
- T Ponchon
- Digestive Disease Department, Edouard Herriot Hospital, Lyon, France.
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38
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Tominaga K, Arakawa T, Ando K, Umeda S, Shiba M, Suzuki N, Watanabe T, Takaishi O, Fujiwara Y, Uchida T, Fukuda T, Higuchi K, Kuroki T. Oesophageal cavernous haemangioma diagnosed histologically, not by endoscopic procedures. J Gastroenterol Hepatol 2000; 15:215-9. [PMID: 10735548 DOI: 10.1046/j.1440-1746.2000.02042.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Haemangioma of the oesophagus is uncommon in patients with benign oesophageal tumours. We present a patient with an oesophageal haemangioma detected during mass screening of the upper gastrointestinal tract. The patient, a 59-year-old man, had neither abdominal complaints nor a history of gastrointestinal diseases. Endoscopic examination revealed a blue-coloured submucosal tumour (approximately 3 cm in diameter) at the middle portion of oesophagus. Endoscopic Doppler ultrasonography showed an homogeneous and hypoechoic mass without blood flow in the submucosal layer of the oesophagus. However, a magnetic resonance imaging scan did not give a typical image for oesophageal haemangioma. Therefore, partial resection of the tumour was performed to obtain a differential diagnosis using the procedures of endoscopic ligation and polypectomy. Histological examination of the resected tissue showed a cavernous haemangioma in the oesophagus. This endoscopic technique may be useful for the differential diagnosis of oesophageal haemangioma.
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Affiliation(s)
- K Tominaga
- Third Department of Internal Medicine, Osaka City University Medical School, Osaka, Japan
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Kojima T, Takahashi H, Parra-Blanco A, Kohsen K, Fujita R. Diagnosis of submucosal tumor of the upper GI tract by endoscopic resection. Gastrointest Endosc 1999; 50:516-22. [PMID: 10502173 DOI: 10.1016/s0016-5107(99)70075-1] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Submucosal tumors are frequent findings during endoscopy, although definitive diagnosis based on histologic confirmation presents some difficulties. The aim of this study was to evaluate the efficacy and safety of endoscopic resection based on endoscopic ultrasonography (EUS) findings to reach a definitive diagnosis of submucosal tumor. METHODS Fifty-four submucosal tumors of the upper gastrointestinal (GI) tract were included in this study. EUS was performed to determine the layer of origin and location of the lesion and to rule out malignancy. En bloc resection was attempted for lesions originating in the muscularis mucosa or submucosa. For tumors originating in the muscularis propria, we performed partial resection limited to the covering mucosa to expose the lesion and obtained a sample with standard biopsy forceps. RESULTS Sufficient samples were obtained in all 54 cases. There was no perforation. Bleeding occurred in only 5 cases (9%) and was easily managed with endoscopic hemostatic methods. EUS and pathologic findings coincided in 74.1% of cases (40 of 54). Benign lesions (leiomyoma, aberrant pancreas, and others) were predominant (52 of 54), although 2 small lesions were confirmed at pathologic study to be malignant (leiomyosarcoma and leiomyoblastoma). CONCLUSIONS Endoscopic resection based on EUS findings proved to be an effective and safe method to confirm the histologic diagnosis of submucosal tumor of the upper GI tract. Endoscopic resection should be considered a valuable choice for definitive management of benign submucosal tumors originating in the superficial layers.
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Affiliation(s)
- T Kojima
- Division of Gastroenterology, Department of Internal Medicine, Fujigaoka Hospital, Showa University, Yokohama, Japan
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Benchimol D, Myx A, Mouroux J, Baqué P, Bernard JL, Bourgeon A, Richelme H. [Adenocarcinoma in Barrett's esophagus. A study of 28 resected cases]. CHIRURGIE; MEMOIRES DE L'ACADEMIE DE CHIRURGIE 1999; 124:141-8. [PMID: 10349750 DOI: 10.1016/s0001-4001(99)80056-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
STUDY AIM The aim of this retrospective study was to report a series of 28 patients with adenocarcinoma (ADK) arising in Barrett's esophagus (BE), treated by esophagectomy. PATIENTS AND METHODS From 1992 to 1998, 28 patients were operated on for ADK in BE. There were 27 men and one woman (mean age: 65 years) classified as ASA I (n = 2), ASA II (n = 15) and ASA III (n = 11). Eighteen patients had a long story of gastro-esophageal reflux disease which required surgical repair in five of them. Dysphagia was the main symptom (n = 19). Surgical procedures included 15 Ivor Lewis operations, nine esophagectomies without thoracotomy and four esophagogastrectomies by the left thoracic approach. RESULTS Pathological examination of the specimens showed an EBO with adenocarcinoma (n = 27) and a high grade dysplasia (n = 1). Among five patients with a previously known BE, three under endoscopic surveillance had high grade dysplasia (n = 1) and limited T1 tumor (n = 2), while the other two patients without surveillance developed an invasive tumor (T3N1). There were three postoperative deaths (mortality rate: 10%), all arising from pulmonary failure. Median survival was 16.6 months. All patients resumed a normal diet. The actuarial survival rates were 63%, 42% and 15.2% respectively at 1, 2 and 4 years. A multivariate analysis could identify 3 prognostic factors: ASA score previously known BE under surveillance, length of BE. CONCLUSION Adenocarcinoma arising in BE is very often diagnosed too late. Patients with high risk BE require an endoscopic survey. High grade dysplasia detected in two successive examinations by two different pathologists may require prophylactic esophagectomy, but local endoscopic management presently under evaluation could be efficient in the future.
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Affiliation(s)
- D Benchimol
- Service de chirurgie abdominale et thoracique, hôpital de l'Archet II, Nice, France
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