Successful removal of an esophageal submucosal tumor by submucosal tunneling endoscopic resection technique
Hiroyuki Aihara, MD, PhD
The Division of Gastroenterology, Hepatology and Endoscopy
Brigham and Women’s Hospital
Boston, Massachusetts, USA

In this video, we describe a case of submucosal esophageal tumor successfully removed by a submucosal tunneling endoscopic resection (STER) technique. This is a 32-year-old male with a history of dysphagia. His EGD revealed a 20mm submucosal tumor at the gastroesophageal junction. EUS at outside hospital revealed a hypoechoic mass arising from the superficial 4th layer. In this case, direct vision of the tumor surface proved that the proper muscle layer was not involved by the tumor, suggesting that the tumor arose from the submucosal layer. Finally, resection was completed without injury to the muscle layer.

Figure 1A. A 20mm submucosal mass was observed at the gastroesophageal junction.
Figure 1B. In this case, the lesion was first isolated from the muscularis propria. Subsequently, submucosal dissection was continued to separate the mucosal layer from the tumor surface.

A running stitch was chosen for closure of the submucosal tunnel, as a running stitch has been shown to result in more secure closure and decreased cost as compared to the interrupted stitch. Histopathologic examination led to the diagnosis of granular cell tumor, which does have malignant potential. His dysphagia resolved immediately after the tumor removal.

This video demonstrated that the combination of short length needle knife and countertraction accomplished through use of an attachment hood allowed for fine needle dissection of the submucosal tissue as performed in the STER procedure.

A running stitch using an endoscopic suturing device facilitated secure closure of the tunnel entrance.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.