Submucosal Tunnel Endoscopic Resection of Giant Leiomyoma of the Esophagus Combined with Circular Arc Incision and 3D Volume Rendering

Summary

The protocol describes the detailed steps for treating patients with giant esophageal leiomyoma (GEL, > 10 cm) and achieving complete resection safely and effectively using endoscopic submucosal tunneling and resection.

Abstract

Esophageal leiomyoma is a common benign tumor of the esophagus. Traditionally, surgical resection is performed for large lesions. In this case, a 19-year-old male patient with a GEL underwent three-dimensional volume rendering to assess the surrounding structures, followed by submucosal tunneling and resection (STER). A modified arc-shaped mucosal incision was designed to provide sufficient exposure for dissection and complete removal of the lesion. Postoperative pathology confirmed leiomyoma. The patient resumed oral intake on postoperative day 2 and was discharged on day 5. STER creates a submucosal tunnel between the mucosal and muscular layers of the digestive tract and is mainly used for removing small esophageal and cardia submucosal tumors originating from the muscularis propria. It offers several advantages, including a short operation time, minimal trauma, rapid recovery, and no visible scars. In this case, STER was successfully applied to remove a large lesion, indicating that endoscopic treatment of GEL is both safe and feasible. However, further experience is required to evaluate its long-term efficacy.

Introduction

Giant esophageal leiomyoma is generally defined as a tumor measuring ≥10 cm in diameter and represents a rare benign neoplasm arising from the muscularis propria of the esophagus^1,2. Although most esophageal leiomyomas exhibit indolent growth and minimal malignant potential, large tumors may cause progressive dysphagia, retrosternal discomfort, and even compression of adjacent mediastinal structures, rendering management technically demanding. Conventional treatment consists of open thoracotomy or thoracoscopic enucleation, and in selected cases partial esophagectomy. While these approaches provide relia....

Protocol

The patient provided written informed consent for the use of medical data. This manuscript reports a single clinical case and does not involve prospective clinical study, retrospective cohort analysis, or any experimental intervention beyond routine clinical management. Written informed consent for publication was obtained from the patient prior to manuscript submission. Therefore, there is no specific IRB approval number applicable to this report

1. Preoperative examination and resectability assessment

1. The patient completed routine blood tests, blood coagulation tests, an electrocardiogram, and pulmonary functi....

Results

The surgery was successfully completed, and the specimen was completely removed. The total operation time was 150 min. The nasogastric tube was removed 24 h postoperatively, and a liquid diet gradually started. The patient was discharged smoothly on POD5. Postoperative chest CT suggested complete resection of the esophageal lesion. Pathology revealed leiomyoma, and immunohistochemical staining showed H-cald and α-SMA (diffuse+), CD117, Dog1, and CD34(-), Ki-67 (<1%+), SDH-B(-), PHH3 (mitotic figures <2/50HPF), and .......

Discussion

Esophageal leiomyoma is a common benign esophageal tumor, usually solitary, and mostly occurs in the middle and lower esophagus. Dysphagia, pain, and weight loss are the most common clinical manifestations⁶. Extremely rare esophageal leiomyomas grow to >10 cm and are called giant esophageal leiomyomas (GELs)^2,7. Most GEL patients experience symptoms such as dysphagia and chest tightness. In this case, the patient presented with dysphag.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
1.5-mm Disposable mucosal incision knife	Anrei, HangZhou, China	EK-410D
A transparent cap	Top Corporation, Tokyo, Japan	Elastic Touch F-030
Endoscopic image processing device	Olympus (Japan)	CV-290
High Frequency Electrotome	Erbe, Tübingen, Germany	VIO 200 D
High-frequency hemostatic forceps	Olympus (Japan)	FD-410LR
metal clips	AGS, HangZhou, China	16mm,AG-51044-1950-135-16
Single Use Injector	MICRO-TECH(Nanjing)	IN02-25423230
Snare Master	MT, NanJing, China	MTN-PFS-A-28/23
standard gastroscope	Olympus	GIF-260J