Submucosal Tunneling and Endoscopic Resection of an Esophageal Leiomyoma in a 13-Year-Old Male.
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INTRODUCTION: 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. PATIENT AND METHODS: 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.