Retrospective study of endoscopic submucosal tunnel dissection (ESTD) for surgical resection of esophageal leiomyoma

Surg Endosc. 2013 Nov;27(11):4259-66. doi: 10.1007/s00464-013-3035-z. Epub 2013 Aug 17.

Abstract

Background: Esophageal leiomyoma is benign and often asymptomatic, but if the tumor is too large or obstructive, it should be resected. The aim of this study was to compare a novel approach, endoscopic submucosal tunnel dissection (ESTD), with a more established method, endoscopic submucosal dissection (ESD).

Methods: This was a retrospective study of 39 patients in Chongqing Xinqiao Hospital, China, undergoing resection for leiomyoma >2 cm in diameter, or 1.5-2.0 cm in diameter with symptoms of obstructive dysphagia. Epidemiological data, presenting symptoms, diagnostic investigations, tumor location, histopathological findings, and safety and efficacy of surgical resection were analyzed.

Results: Mean tumor sizes in the ESTD (n = 18; mean age = 36.7 ± 6.3 years) and ESD (n = 21; age = 41.0 ± 4.4 years) groups were 3.3 ± 0.7 and 3.0 ± 0.4 cm, respectively. The male:female ratio was 25:14, with a distribution of lesions among the lower, middle, and upper esophagus of 22:14:3. Operating time was significantly shorter (p < 0.05) for ESTD (67.5 ± 9.5 min) than for ESD (87.2 ± 7.7 min), while incision healing was faster (p < 0.05) for ESTD (14.7 ± 2.5 days) than for ESD (57.9 ± 7.5 days). Hospital stay was also shorter (p < 0.05) for ESTD (2.3 ± 0.5 days) than for ESD (5.7 ± 1.0 days). Bleeding was the only complication with ESTD (3/18 patients), with no significant difference in the incidence of complications between groups. ESTD was rapidly learned by surgeons.

Conclusion: ESTD is a safe and effective treatment for esophageal leiomyoma, with advantages over ESD.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • China
  • Dissection / methods*
  • Endoscopy, Digestive System / methods*
  • Esophageal Neoplasms / pathology
  • Esophageal Neoplasms / surgery*
  • Female
  • Humans
  • Leiomyoma / pathology
  • Leiomyoma / surgery*
  • Length of Stay
  • Male
  • Mucous Membrane / surgery
  • Retrospective Studies
  • Treatment Outcome