Halpern Alex I, Byrd Chad E, Petrosyan Mikael, Sandler Anthony D, Kane Timothy D
Department of General and Thoracic Surgery, Children's National Medical Center, Washington, DC, USA.
Ann Surg Oncol. 2025 Jul 21. doi: 10.1245/s10434-025-17869-7.
Esophageal leiomyoma, while rare in children, is the most common benign tumor of the esophagus. Many children with leiomyomas present with diffuse disease. Isolated tumors have been managed by primary resection or enucleation with thoracotomy or thoracoscopy. More recently, submucosal tunneling and endoscopic resection (STER) has been used for resection of intramural esophageal masses. 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.
食管平滑肌瘤在儿童中较为罕见，却是食管最常见的良性肿瘤。许多患有平滑肌瘤的儿童表现为弥漫性病变。孤立性肿瘤以往通过开胸或胸腔镜下的初次切除或摘除术进行治疗。最近，黏膜下隧道内镜切除术（STER）已被用于切除食管壁内肿物。这种内镜手术切除技术利用了黏膜下层，如同经口内镜下肌切开术所采用的那样。我们报道了首例使用STER治疗儿童食管平滑肌瘤的病例。
一名13岁白人男性因吞咽困难和频繁腹痛就诊，被诊断为食管远端有一个2厘米的肿物（图1）。初步诊断为食管平滑肌瘤后，患者及其家属选择了STER。使用配有分离帽的180毫米奥林巴斯双通道内镜。在肿物上方进行黏膜切开术，采用钝性分离和电灼分离来接近并切除肿物。黏膜缺损用Resolution Clips™夹闭。图1术前食管造影显示食管远端黏膜下有一个2厘米的肿物 结果：肿物被完整切除。术后第1天的食管造影显示黏膜完整，无黏膜下肿物（图2）。病理证实为平滑肌瘤，切缘阴性。在1年的随访中，患者无吞咽困难、胃食管反流或胸痛症状。图2术后第1天食管造影显示无肿物且无造影剂外渗 结论：这是首例关于儿童食管平滑肌瘤STER治疗的报道。对于有先进内镜介入手术经验的医疗人员来说，STER是治疗儿童食管平滑肌瘤的一种合理手术方法。
