Endoscopic submucosal dissection of a giant esophageal lymphangioma

Abstract

Fig. 2 Endoscopic submucosal dissection (ESD) procedure. a The resection borders were marked. b A solution of indigo carmine and glycerol was injected to lift the submucosa. The mucosa was cut around the lesion. c A clip with dental floss provided traction. d The lesion was quickly peeled away using an insulation-tipped knife. e The tumor was resected en bloc. f The tumor was divided into smaller pieces and retrieved from the esophagus using a snare. g Endoscopic images after ESD showed a flat ulcer. h, I No residual tumor or stenosis was observed endoscopically at 4 months after treatment.

Esophageal lymphangioma: a case report and review of literature

“…They may be asymptomatic or may have various chief complaints, depending upon the location and size of a tumor. Dysphagia, as shown in our case, is the most common [14, 25, 27, 28]. Other common symptoms include heartburn and epigastric pain, which may be related to coexisting gastropathy and reflux disease [13, 22].…”

“…The overlying mucosa is normal-appearing under white light endoscopy. A large tumor may be lustrous and translucent [27, 28]. Esophageal EUS is routinely used to evaluate the size and depth of a lesion.…”

“…The classical characteristics of esophageal lymphangioma under EUS manifest a honeycomb- or grid-like multi-microcystic echo pattern and the lesion may involve lamina propria and submucosal layer. Sometimes, the echo pattern may vary, according to the size of dilated lymphatic vessels [17, 20, 27, 28]. EUS examination is very helpful to differentiate lymphangioma from leiomyoma, the most frequent esophageal SMT, because EUS is able to clearly exhibit the micro-cystic echo pattern and the underlying intact muscularis propria.…”

“…Endoscopic resection has become the treatment of choice for gastrointestinal SMT with advantages over surgery in safety, effectiveness, minimal injury, and better quality of life after resection. Numerous endoscopic treatment methods have been gradually used to resect esophageal lymphangioma, such as dual-channel endoscopic resection, endoscopic resection with ligation device, cap-assisted endoscopic mucosal resection, endoscopic mucosal resection with an electrocautery snare, laser resection and ESD [16, 18, 23, 27, 28].…”