Ligation-assisted endoscopic enucleation for treatment of esophageal subepithelial lesions originating from the muscularis propria: a preliminary study

Abstract

An innovative ligation-assisted endoscopic enucleation (EE-L) technique was developed for the diagnosis and treatment of esophageal subepithelial lesions (smaller than 12 mm) originating from muscularis propria by combining endoscopic band ligation and endoscopic enucleation techniques. The aim of the study was to evaluate efficacy and safety of EE-L technique in the treatment of esophageal subepithelial lesions (smaller than 12 mm) originating from muscularis propria. Forty-seven esophageal subepithelial lesions (smaller than 12 mm) originating from the muscularis propria in 44 patients were treated with EE-L between September 2010 and September 2012. The lesion was first aspirated into the transparent cap attached to the tip of endoscope. The elastic band was then released around its base. The purpose of ligation was to force the lesion to assume a polypoid form with a pseudostalk. Endoscopic enucleation was then performed until the tumor was completely enucleated from muscularis propria using a hook knife and forceps. All tumors (median diameter: 8.2 ± 2.3 mm, range: 4-12 mm) were enucleated completely. Histopathology identified 45 tumors (95.7%) as leiomyoma, 2 (4.3%) tumors as gastrointestinal stromal tumor with very low risk. The mean time of the EE-L procedure was 12.5 ± 4.6 minutes (range: 6-23 minutes). Two patients experienced self-limiting, non-life-threatening hemorrhage after EE-L. No perforation and massive hemorrhage requiring further endoscopic or surgical intervention occurred. There were no recurrences during the 6-24 months follow-up period. EE-L offers the option of localized treatment of small esophageal muscularis propria tumors (smaller than 12 mm) with relatively few complications and low mortality, and provides the advantage of allowing a histopathological diagnosis. All the resected lesions in this study had a benign pathology.

Retrospective Analysis of Thoracoscopic Surgery for Esophageal Submucosal Tumors

“…However, some recent reports have evaluated the use of esophagoscopy as a less invasive approach for enucleation using esophagoscopy. Guo et al [ 7 ] reported their experience performing endoscopic enucleation on submucosal tumors smaller than 12 mm in 47 patients, and concluded that endoscopic enucleation facilitates the localized treatment of small SMTs with relatively few complications and is advantageous for histological diagnosis. We do not routinely perform endoscopic biopsies if submucosal tumors show benign patterns in computed tomography and EUS.…”

Ligation-Assisted Endoscopic Enucleation for the Resection of Gastrointestinal Tumors Originating from the Muscularis Propria: Analysis of Efficacy and Facility

“…Several endoscopic resection techniques have been proven to be feasible and safe including ESD, endoscopic enucleation, endoscopic ligation, endoscopic ligation and resection, endoscopic full-thickness resection and submucosal tunneling endoscopic resection [4] .…”

Ligation‐assisted endoscopic enucleation for the treatment of colorectal submucosal tumours originating in the muscularis propria

“…By combining endoscopic band ligation and endoscopic enucleation, a new ligation‐assisted endoscopic enucleation (EE‐L) technique was developed to combine the advantages of both techniques. In a preliminary study, EE‐L was demonstrated to be a safe, effective and simple method that could be used for the histological diagnosis and excision of small tumours originating in the muscularis propria in the oesophagus , but is is unclear whether it can be used to treat submucosal colorectal tumours originating in the muscularis propria.…”