Hyun J H, Jeen Y T, Chun H J, Lee H S, Lee S W, Song C W, Choi J H, Um S H, Kim C D, Ryu H S
Dept. of Internal Medicine, College of Medicine, Korea University, Seoul, Korea.
Endoscopy. 1997 Mar;29(3):165-70. doi: 10.1055/s-2007-1004157.
Although most submucosal tumors of the esophagus are benign, reliable exclusion of leiomyosarcoma requires histological analysis. However, this is rarely possible with an endoscopic forceps biopsy. In an attempt to establish the diagnosis, and as an alternative to surgery, we present here our experience with the endoscopic removal of submucosal tumors of the esophagus using two different techniques.
Sixty-two patients (38 men, 24 women, mean age 47) with submucosal tumors of the esophagus were treated endoscopically. If the tumor was less than 2 cm in diameter, polypoid, or showed a round protrusion with at least moderate elevation at endoscopy, a conventional snare polypectomy was performed. If the tumor was larger than 2 cm in diameter or only mildly elevated, the technique of modified endoscopic incisional enucleation was carried out, consisting of complete stripping of the overlying tissue followed by tumor enucleation using an electrocautery snare and a coagulation electrode.
Based on these criteria, 36 patients underwent conventional snare polypectomy, and 25 received endoscopic incisional enucleation; complete resection of the tumor was possible in these 61 cases. In one patient, only partial removal was possible, due to firm and wide adhesions to the surrounding tissue. The tumor diameters ranged from 0.6 cm to 7.5 cm, with a mean value of 1.9 cm; 14 tumors measured more than 3 cm. At histopathology, the resected specimens were found to be 56 leiomyomas, four granular cell tumors, one neurogenic tumor, and one cyst. No serious complications such as perforation or massive bleeding occurred, and oozing bleeding, which was encountered in three patients, was easily managed by endoscopic electrocoagulation. During the follow-up period (mean 38.4 months, range 3-107 months) no recurrence was observed in any of the 61 patients who received complete resections.
This method of endoscopic removal of submucosal tumors of the esophagus appears to be safe and effective in experienced hands. It allows complete histopathological workup, and at the same time complete removal of the tumor. The method can be considered as an alternative to surgery in symptomatic cases.
尽管大多数食管黏膜下肿瘤是良性的，但要可靠地排除平滑肌肉瘤需要进行组织学分析。然而，通过内镜活检钳活检很少能做到这一点。为了尝试确立诊断，并作为手术的替代方法，我们在此介绍我们使用两种不同技术内镜切除食管黏膜下肿瘤的经验。
62例食管黏膜下肿瘤患者（38例男性，24例女性，平均年龄47岁）接受了内镜治疗。如果肿瘤直径小于2 cm、呈息肉样或在内镜检查时显示为圆形隆起且至少有中度隆起，则进行传统圈套息肉切除术。如果肿瘤直径大于2 cm或仅轻度隆起，则采用改良内镜切开摘除术，包括完全剥离覆盖组织，然后使用电凝圈套器和凝血电极摘除肿瘤。
根据这些标准，36例患者接受了传统圈套息肉切除术，25例接受了内镜切开摘除术；这61例患者均实现了肿瘤的完全切除。1例患者因与周围组织紧密且广泛粘连，仅能部分切除。肿瘤直径范围为0.6 cm至7.5 cm，平均值为1.9 cm；14个肿瘤直径超过3 cm。组织病理学检查发现，切除标本中有56个平滑肌瘤、4个颗粒细胞瘤、1个神经源性肿瘤和1个囊肿。未发生穿孔或大量出血等严重并发症，3例患者出现的渗血通过内镜电凝很容易处理。在随访期（平均38.4个月，范围3至107个月），61例接受完全切除的患者均未观察到复发。
这种内镜切除食管黏膜下肿瘤的方法在有经验的医生操作下似乎是安全有效的。它能够进行完整的组织病理学检查，同时完全切除肿瘤。在有症状的病例中，该方法可被视为手术的替代方法。
