Endoscopic resection of subepithelial tumors

Abstract

Subepithelial tumors (SETs) are often incidentally found during endoscopic examinations. Endoscopic ultrasonography (EUS) is a good method for differential diagnosis of SETs, but a definite diagnosis cannot be made based on EUS features alone in some cases. Periodic follow-up examinations by endoscopy and EUS remains the recommended management strategy, which involves issues related to patient compliance, cost-effectiveness, and the risk associated with repeated endoscopic procedures and delayed diagnosis of malignancy. Endoscopic resection of the SETs is another technique to treat them as well as to obtain tissue specimens for accurate histologic diagnosis. Herein, a various endoscopic techniques ranging from simple snare resection to endoscopic submucosal tunnel dissection for the management of SETs will be reviewed.

Keywords: Endoscopic resection; Neoplasms; Subepithelial.

Fig. 1

Standard snare polypectomy of a gastric inflammatory fibrinoid polyp. (A) A subepithelial tumor is observed at the angle. (B) The tumor is hypoechoic and located in the submucosal layer on endoscopic ultrasonography. (C) Submucosal injection is done to elevate the lesion from the proper muscle layer. (D) The tumor is resected by using a snare. (E) The lesion is completely removed. (F) Inner surface of the resected specimen.

Fig. 2

Endoscopic submucosal resection of an esophageal granular cell tumor with a ligation device. (A) A subepithelial tumor is observed at the lower esophagus. (B) Saline solution with small amount of epinephrine and indigo carmine dye is injected beneath the lesion to elevate it. (C) The lesion is then aspirated into the ligation device, followed by deployment of the elastic band. (D) Snare resection is performed using blended electrosurgical current. (E) The lesion is completely removed. (F) Inner surface of the resected specimen.

Fig. 3

Endoscopic submucosal dissection of an esophageal leiomyoma using electrosurgical knife. (A) A large subepithelial tumor is observed at the lower esophagus. (B) The tumor is hypoechoic and located mainly in the submucosal layer on endoscopic ultrasonography. (C) After midline incision of overlying normal mucosa, a subepithelial tumor is exposed. (D) Submucosal dissection of the tumor is performed by using an IT-knife. (E) The lesion is completely removed. (F) The resected specimen.