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A 49-year-old woman undergoing screening esophagogastroscopy was found to have an
esophageal subepithelial mass at 24 cm from incisors (Fig. 1A). Miniprobe and curvilinear endosonography revealed a 1.1 × 0.6 cm, homogeneously
hypoechoic mass originating from muscularis propria adjacent to the aorta, exhibiting
intraluminal protrusion (Fig. 1B and C). On her demand to remove the lesion, submucosal tunnel endoscopic resection
(STER) was performed. Mucosal incision was made at 21 cm from incisors to initiate
the tunnel, which was extended to 26 cm from incisors only to give no sign of the
lesion (Fig. 1D). Under the circumstances, the miniprobe was introduced into the tunnel and visualized
the mass, which was just beneath the inner surface of tunnel and became exophytic,
leaving no optical view of protrusion (Fig. 2A). Assisted by EUS, the lesion was precisely located, cautiously excavated, gradually
exposed and uneventfully resected (Fig. 2B-G). Discharged two days later, the patient didn't complain of any postoperative
discomfort. Histopathology confirmed leiomyoma.
Fig. 1Endoscopic view of an esophageal subepithelial bulge (A), EUS miniprobe view of a
homogeneously hypoechoic mass originating from muscularis propria with an ingrowth
pattern (B), and curvilinear echoendoscopic view of the mass adjacent to aorta (C).
The lesion was not found inside the submucosal tunnel (D).
Fig. 2EUS miniprobe inside the tunnel made the lesion reemerge (A). Digging initiated at
the location provided by EUS (B). Deep excavation gradually exposed the lesion (C
and D). Partial layer of muscularis propria was preserved (E). Mucosal entrance closed
with clips (F). The resected specimen (G).
Submucosal tunnel endoscopic resection: a new technique for treating upper GI submucosal tumors originating from the muscularis propria layer (with videos).
