Utility of endoscopic ultrasonography in assessing the indications for endoscopic surgery of submucosal esophageal tumors

Background: The submucosal tumor (SMT) of the esophagus presents good indic ations for minimal invasive surgery, such as endoscopic or thoracoscopic re section. However, it is essential that the layer of origin be acertained, T he SMT can be detected as hypoechoic lesions in the wall of the esophagus, and the intramural location can be estimated in terms of destruction or dev iation of the ultrasonic layer structure of the esophagus. Methods: To test the efficacy of this approach, a series of patients were e xamined by an endoscopic ultrasonography (EUS). Results: In one patient, the lesion was diagnosed as located in the muscula ris mucose, and endoscopic resection was performed. Tn another four patient s, the lesions-appeared to be in the proper muscle layer, and enucleation w as carried out under thoracoscopy or open surgery. Histologically, all of t he lesions were leiomyomas, and the EUS diagnosis was correct in all of the patients. Conclusions: Thus, the intramural condition of SMTs can be estimated and in dications for endoscopic or thoracoscopic resection assessed by this approa ch.