Endoscopic Ultrasound-Assisted Tunnel-Type Endoscopic Submucosal Dissection for the Treatment of Esophageal Tumors Arising in the Muscularis Propria (with video)

Objective: Esophageal tumors arising in the muscularis propria are difficult to be resected endoscopically using standard electro-surgical techniques, even the endoscopic submucosal dissection (ESD) technique appeared recently. Our purpose is to investigate the efficacy of endoscopic ultrasound (EUS)-assisted tunnel-type ESD for resection of these tumors.

Methods: A total of 17 patients were included in this study. A standard endoscope was used. The submucosal tunnel was created with the triangle knife according to the standard ESD technique, about 5 cm proximal to the lesion. EUS was performed within the tunnel to detect the tumor, and then the tumor was separated both from the submucosal and the muscle layers. After the tumor was removed, several clips were used to close the mucosal defect. EUS was performed to evaluate the healing quality 1 week after the procedure.

Result: In all the cases, the tumors were completely resected. Mean tumor size was 24.2 mm (12-50 mm) in diameter. The histo-logical diagnoses were leiomyoma (16/17) and gastrointestinal stromal tumor (GIST, 1/17). Subcutaneous emphysema was found in 2 patients after the procedure, but disappeared by the third day. No patients sustained perforation or developed significant hem-orrhage, and there were no other immediate severe complications after the procedure. The healing quality was satisfying in 16/17 patients evaluated by EUS 1 week after the procedure. No recurrence has been found during follow-up (mean 7 months, range 3-13 months).

Conclusion: EUS-assisted tunnel-type ESD is effective and safe in treatment of esophageal tumors arising in the muscularis pro-pria.