Submucosal Tunneling and Endoscopic Resection of an Esophageal Leiomyoma in a 13-Year-Old Male.

Abstract

Esophageal leiomyoma, while rare in children, is the most common benign tumor of the esophagus.¹ Many children with leiomyomas present with diffuse disease.^2-4 Isolated tumors have been managed by primary resection or enucleation with thoracotomy or thoracoscopy.^5,6 More recently, submucosal tunneling and endoscopic resection (STER) has been used for resection of intramural esophageal masses.^7-14 This technique for endoscopic surgical resection takes advantage of the submucosal plane, as employed in the per-oral endoscopic myotomy procedure. We describe the first use of STER to treat an esophageal leiomyoma in a child. A 13-year-old white male presented with dysphagia and frequent abdominal pain and was diagnosed with a 2-cm distal esophageal mass (Fig. 1). With a presumptive diagnosis of esophageal leiomyoma, the patient and family opted for a STER. A 180-mm Olympus double-channel endoscope was used with a dissecting cap. A mucosotomy was performed above the mass, and blunt and cautery dissection were used to approach and remove the mass. The mucosal defect was closed with Resolution Clips™. Fig. 1 Preoperative esophagram revealing a 2-cm distal submucosal mass of the esophagus RESULTS: A complete resection of the mass was achieved. An esophagram on postoperative day 1 revealed intact mucosa and no submucosal mass (Fig. 2). Pathology confirmed leiomyoma with negative margins. At 1-year follow-up, the patient had no dysphagia, gastroesophageal reflux, or chest pain. Fig. 2  Postoperative day 1 esophagram revealing absence of mass and no contrast extravasation CONCLUSIONS: This represents the first report of STER of an esophageal leiomyoma in a child. For providers with experience with advanced endoscopic interventional procedures, STER represents a reasonable operative approach for esophageal leiomyomas in children.