Endoscopic submucosal dissection for esophageal granular cell tumor using the clutch cutter

Abstract

Endoscopic submucosal dissection (ESD) with a knife is a technically demanding procedure associated with a high complication rate. The shortcomings of this method are the deficiencies of fixing the knife to the target lesion, and of compressing it. These shortcomings can lead to major complications such as perforation and bleeding. To reduce the risk of complications related to ESD, we developed a new grasping type scissors forceps (Clutch Cutter®, Fujifilm, Japan) which can grasp and incise the targeted tissue using an electrosurgical current. Esophagogastroduodenoscopy on a 59-yearold Japanese man revealed a 16mm esophageal submucosal nodule with central depression. Endoscopic ultrasonography demonstrated a hypoechoic solid tumor limited to the submucosa without lymph node involvement. The histologic diagnosis of the specimen obtained by biopsy was granular cell tumor. It was safely and accurately resected without unexpected incision by ESD using the CC. No delayed hemorrhage or perforation occurred. Histological examination confirmed that the granular cell tumor was completely excised with negative resection margin.We report herein a case of esophageal granular cell tumor successfully treated by an ESD technique using the CC.

Tumor de células granulares esofágico,metodología de estudio y diagnósticos diferenciales: reporte de un caso

“…En tal sentido, el abordaje endoscópico es preferido por sobre la resección quirúrgica tradicional, resultando menos invasivo y con baja tasa de complicaciones. 12 La resección mucosa, constituye la técnica endoscópica más utilizada, presentando como limitantes, el tamaño de la lesión > 1 cm y el compromiso de la capa muscularis mucosae o profunda. 13 Por su parte la disección submucosa, realizada por profesionales capacitados, resulta una técnica ideal, con posibilidad de extracción de lesiones de mayor tamaño y en bloque desde capas más profundas como la submucosa.…”

Esophageal granular cell tumor: A case report

“…Observation of these tumors is indicated unless the patient is symptomatic or the tumor is greater than 1 cm or has atypical endoscopic ultrasonographic or histologic features[ 7 ]. The most preferred treatment option for eGCT is endoscopic resection, which is highly associated with bleeding and perforation[ 9 , 10 ]. Although most granulocytomas are benign and grow slowly, about 2% of granulocytomas are malignant, which require surgery.…”

Endoscopic Submucosal Dissection as Diagnostic Treatment for Gastric Granular Cell Tumor Confined to the Submucosa

“…Although most GCTs that originate from Schwann cells are benign, about 2% of malignant cases have been reported. It is also difficult to differentiate malignant potential tumors such as GIST and NET by using biopsied specimens obtained from EUS-FNA and endoscopic images [1,2,5]. The present case shows that ESD could be a useful option for the diagnostic treatment of SMT located in the submucosal layer with minimal invasiveness, because this technique allows en-bloc resection and corrects pathological diagnosis.…”