ENDOSCOPIC ASPIRATION LUMPECTOMY OF ESOPHAGEAL LEIOMYOMAS DERIVED FROM THE MUSCULARIS MUCOSAE

Objectives: There is still much debate about the indications and best technique for endoscopy for the treatment of esophageal leiomyomas. We developed a novel technique for endoscopic aspiration lumpectomy and used it in patients with esophageal leiomyomas derived from the muscul aris mucosae. Methods: Nine patients with esophageal leiomyomas were t reated with informed consent. The indication for intervention was base d on the endosonographic confirmation of a tumor originating from the 2nd layer of the esophagus. We attached a transparent cylinder to the tip of an endoscope and a snare-guide tube to the outer axis of the sc ope. After endoscopic suction of the tumor into the cylinder, the snar e was pushed open. The tumor was grabbed at its base with the entire s urrounding mucosa, and removed. Results: The overall procedure time av eraged 18 minutes, and there were no complications in any of the subje cts. The resected specimens were elliptical with a mean long diameter of 22 +/- 4 mm and a mean short diameter of 17 +/- 4 mm. Complete rese ction was possible in eight of the nine tumors that were under 2 cm in diameter. After a follow-up period of 4 to 27 months (mean 11 months) , no recurrence was found in any of the completely resected cases. Con clusions: Endoscopic aspiration lumpectomy has been proven to be a saf e, effective, and less invasive procedure for small esophageal leiomyo mas derived from the muscularis mucosae.