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. 2007 Sep 28;13(36):4897-902.
doi: 10.3748/wjg.v13.i36.4897.

Endoscopic management of gastrointestinal smooth muscle tumor

Xiao-Dong Zhou  1 , Nong-Hua Lv, Hong-Xia Chen, Chong-Wen Wang, Xuan Zhu, Ping Xu, You-Xiang Chen
Affiliations

Endoscopic management of gastrointestinal smooth muscle tumor

Xiao-Dong Zhou et al. World J Gastroenterol. .

Abstract

Aim: To systematically evaluate the efficacy and safety of endoscopic resection of gastrointestinal smooth muscle tumors (SMTs, including leiomyoma and leiomyosarcoma) and to review our preliminary experiences on endoscopic diagnosis of gastrointestinal SMTs.

Methods: A total of 69 patients with gastrointestinal SMT underwent routine endoscopy in our department. Endoscopic ultrasonography (EUS) was also performed in 9 cases of gastrointestinal SMT. The sessile submucosal gastrointestinal SMTs with the base smaller than 2 cm in diameter were resected by "pushing" technique or "grasping and pushing" technique while the pedunculated SMTs were resected by polypectomy. For those SMTs originating from muscularis propria or with the base size >or= 2 cm, ordinary biopsy technique was performed in tumors with ulcers while the "Digging" technique was performed in those without ulcers.

Results: 54 cases of leiomyoma and 15 cases of leiomyosarcoma were identified. In them, 19 cases of submucosal leiomyoma were resected by "pushing" technique and 10 cases were removed by "grasping and pushing" technique. Three cases pedunculated submucosal leiomyoma were resected by polypectomy. No severe complications developed during or after the procedure. No recurrence was observed. The diagnostic accuracy of ordinary and the "Digging" biopsy technique was 90.0% and 94.1%, respectively.

Conclusion: Endoscopic resection is a safe and effective treatment for leiomyomas with the base size <or= 2 cm. The "digging" biopsy technique would be a good option for histologic diagnosis of SMTs.

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Figures

Figure 1
Figure 1
Schematic diagram for “pushing” technique. A: The snare was placed around the leiomyoma; B: The head (gastroscopy) or anal (colonoscopy) side of leiomyoma was pushed by the insulated cannula of snare to form a semipedunculation; C: The snare was tightened gradually and total leiomyoma was captured; D: The leiomyoma was resected completely.
Figure 2
Figure 2
Endoscopic views for “pushing” resection of a leiomyoma. A: A sessile leiomyoma at antrum of stomach; B: EUS revealed that the mass originated from muscularis mucosa; C: The leiomyoma was pushed by cannula to form a semipedunculation and then captured by snare; D: The captured leiomyoma was resected by high-frequency electrosurgical current; E: The endoscopic view for the cauterization burn of leiomyoma after resection; F: The histologic view of leiomyoma after resection (HE, x 200 ).
Figure 3
Figure 3
A: Endoscopic view of a leiomyosarcoma at corpus of stomach; B: The view of EUS; C: The histologic examination after “digging” technique (HE, x 200).
See this image and copyright information in PMC

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