Endoscopic Ultrasonography in the Diagnosis and Treatment Strategy Choice of Esophageal Leiomyoma

Abstract

OBJECTIVES:Esophageal leiomyoma is the most common benign tumor of the esophagus, and it originates from mesenchymal tissue. This study analyzed the clinicopathological characteristics of esophageal leiomyoma and aimed to evaluate the role of endoscopic ultrasonography in the diagnosis and treatment selection for these lesions.METHODS:Two hundred and twenty-five patients who had suspected esophageal leiomyomas in endoscopic ultrasonography were enrolled at the Endoscopy Center of The First Affiliated Hospital, Zhejiang University from January 1st, 2009 to May 31th, 2015. The main outcomes included the demographic and morphological characteristics, symptoms, comparisons of diagnosis and treatment methods, adverse events, and prognosis.RESULTS:One hundred and sixty-seven patients were diagnosed as having an esophageal leiomyoma by pathological examination. The mean patient age was 50.57±9.983 years. In total, 62.9% of the lesions originated from the muscularis mucosa, and the others originated from the muscularis propria. The median distance to the incisors was 30±12 cm. The median diameter was 0.72±0.99 cm. As determined by endoscopic ultrasonography, most existing leiomyomas were homogeneous, endophytic, and spherical. The leiomyomas from the muscularis mucosa were smaller than those from the muscularis propria and much closer to the incisors (p<0.05). SMA (smooth muscle antibody) (97.2%) and desmin (94.5%) were positive in the majority of patients. In terms of treatments, patients preferred endoscopic therapies, which led to less adverse events (e.g., intraoperative bleeding, local infection, pleural effusion) than surgical operations (p<0.05). The superficial leiomyomas presented less adverse events and better recovery (p<0.05) than deep leiomyomas.CONCLUSION:Endoscopic ultrasonography has demonstrated high accuracy in the diagnosis of esophageal leiomyomas and provides great support in selecting treatments; however, EUS cannot completely avoid misdiagnosis, so combining it with other examinations may be a good strategy to solve this problem.

Endoscopic Approach to Esophageal Leiomyomas: Single Center Results

“…In our study, leiomyomas were found more frequently in men. The mean age of diagnosis in studies was reported to be in the 4 th -5 th decade, and our study had a similar mean age with literature (1,10,14).…”

“…While thoracotomy was the preferred treatment method in the 1990's, later thoracoscopy and laparoscopy replaced it as the more frequently applied treatments (6)(7)(8)(9). The developments in endoscopy in the last few decades have caused an increase in the frequency of using endoscopic treatments (10). Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), which are among the endoscopic treatment options, can be used safely in experienced hands in benign and earlystage malignant tumors (5,10,11).…”

Comparison Between Submucosal Tunneling Endoscopic Resection (STER) and Other Resection Modules for Esophageal Muscularis Propria Tumors: A Retrospective Study

“…Sufang Tu et al [26] has also revealed that esophageal SMTs of MP layer are most commonly detected in the middle segment of the esophagus. However, Ling-Jia Sun et al [27] found that even more esophageal leiomyomas were located in the lower esophagus. However, this study had more inclusion criteria, and some of the leiomyomas arose from muscularis mucosae.…”

Diagnosis And Surgical Treatment Of Esophageal Leiomyoma

“…Autopsy series have demonstrated that benign tumors of the esophagus are rarefound in 0.005-7.9% of cases and leiomyomas account for 70 to 80% of these tumors [2,3]. Most cases are diagnosed in adults aged between 20 to 80 years, with the majority of the patients being between 40 and 50 years [4]. At least half of the patients are asymptomatic and are often diagnosed incidentally during esophagogastroduodenoscopy (EGDS).…”

“…Malignant transformation of leiomyomas in leiomyosarcomas is extremely rare and is reported in less than 1%. Combined histologic variants of leiomyoma and esophageal adenocarcinoma are described [4,11]. The therapeutic approach depends on the size, location of the tumor as well as the presence of symptoms, the age of the patient or any comorbidity.…”