University of California Los Angeles Los Angeles, CA, United States
Award: Presidential Poster Award
Sagar Shah, MD1, Anastasia Chahine, MD2, Jennifer Kolb, MD, MS3, Rochelle Simoni, BSc4, Alyssa Y. Choi, MD2, Jason Samarasena, MD5 1University of California Los Angeles, Los Angeles, CA; 2H. H. Chao Comprehensive Digestive Disease Center, University of California Irvine, Orange, CA; 3University of California Irvine, Orange, CA; 4UC Irivne, Orange, CA; 5University of California - Irvine, Orange, CA
Introduction: Accurate diagnosis of subepithelial tumors (SET) depends on histologic analysis. With the advent of “third-space” endoscopy techniques, resection of many SETs is possible. Submucosal tunneling endoscopic resection (STER) of gastrointestinal submucosal masses is a novel technique that involves creating a submucosal tunnel between the mucosa and the muscularis propia within which the resection is performed. Here we describe two cases in which STER was used to remove submucosal lesions identified within the esophagus.
Case Description/Methods: The first case was a 57-year-old female presented for evaluation of GERD and was found to have a subepithelial mass on index EGD. Endoscopic ultrasound (EUS) demonstrated a 7.3mm x 5mm hypoechoic lesion arising from either the muscularis mucosa or submucosa. The patient was scheduled for submucosal tunnel endoscopic resection.
To begin the procedure, a small mucosal incision was made 3cm proximal to the lesion. Submucosal dissection with an ESD knife was then performed to create a tunnel to the lesion. Upon visualization, the lesion appeared to be attached with a pedicle to the muscularis propria. The lesion with an intact capsule was detached and a memory basket was used to extract it from the submucosal tunnel. The submucosal tunnel was then closed using hemoclips. There were no immediate or delayed complications. Pathologic analysis was consistent with leiomyoma.
The second case was a 50-year-old female referred for EUS evaluation of a submucosal lesion of the esophagus found on endoscopy performed for evaluation of GERD and diarrhea. EUS demonstrated a 7.3 by 5.6 mm hypoechoic submucosal lesion near the gastroesophageal junction with normal overlying mucosa. The lesion appeared to arise from the muscularis mucosa.
The patient was scheduled for STER, using the same technique as described above. There were no immediate or delayed complications. Pathologic analysis of the lesion was consistent with leiomyoma.
Discussion: STER appears to be a safe and viable technique for the resection of esophageal submucosal tumors. Creation of a tunnel within which the resection is performed allows for resection under direct visualization. STER may also reduce the risk of perforation associated with ESD and EFTR. In these two cases STER was a good alternative to continued surveillance endoscopy which would have been the standard of care had STER not been employed.
Figure: a) Subepithelial lesion in a 57-year-old female appearing as a smooth protuberance with normal overlying mucosa on EGD b) Hypoechoic mass arising from muscularis mucosa or submucosa on EUS c) Mass visualized from within submucosal tunnel prior to resection d) Subepithelial lesion in 50-year-old female near gastroesophageal junction e) Hypoechoic mass arising from muscularis mucosa demonstrated on EUS f) Resected leiomyoma
Sagar Shah indicated no relevant financial relationships.
Anastasia Chahine indicated no relevant financial relationships.
Jennifer Kolb indicated no relevant financial relationships.
Rochelle Simoni indicated no relevant financial relationships.
Alyssa Choi indicated no relevant financial relationships.
Jason Samarasena: Conmed – Consultant. Cook Medical – Consultant. Olympus – Consultant.
Sagar Shah, MD1, Anastasia Chahine, MD2, Jennifer Kolb, MD, MS3, Rochelle Simoni, BSc4, Alyssa Y. Choi, MD2, Jason Samarasena, MD5. P1732 - Resection of Esophageal Tumors Using Submucosal Tunneling Endoscopic Resection (STER), ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.