Clinical outcomes of esophageal granular cell tumors with different endoscopic resection methods

Abstract

Esophageal granular cell tumors (GCTs), the second most common subepithelial tumors (SETs) of the esophagus, are potentially malignant with no definite management guidelines available. We retrospectively enrolled 35 patients with endoscopically resected esophageal GCTs between December 2008 and October 2021 and evaluated the clinical outcomes from the various methods performed. Several modified endoscopic mucosal resections (EMRs) were performed for treating esophageal GCTs. Clinical and endoscopic outcomes were evaluated. Mean age of patients was 55.8 ± 8.2, with majority being men (57.1%). Mean tumor size was 7.2 ± 2.6 mm, most (80.0%) were asymptomatic and present in the distal third of the esophagus (77.1%). Endoscopic characteristics predominantly included broad-based (85.7%) and whitish-to-yellowish color changes (97.1%). Endoscopic ultrasound (EUS) of 82.9% of the tumors revealed homogeneous hypoechoic SETs originating from the submucosa. The five endoscopic treatment methods used were: ligation-assisted (77.1%), conventional (8.7%), cap-assisted (5.7%), and underwater (5.7%) EMRs and ESD (2.9%). Mean procedure time was 6.6 ± 2.1 min, and no procedure-associated complications were noted. The en-bloc and complete histologic resection rates were 100% and 94.3%, respectively. No recurrences were noted during follow-up, and no significant differences in the clinical outcomes of the different methods of endoscopic resection were found. Based on tumor characteristics and therapeutic outcomes, modified EMR methods can be effective and safe. However, there were no significant differences in the clinical outcomes of the different methods of endoscopic resection.

Figure 1

Conventional endoscopic mucosal resection for a 12-mm-sized esophageal granular cell tumor. A narrow-necked, round subepithelial tumor (SET) is detected in the lower esophagus (A). Endoscopic ultrasound (EUS) revealed a hypoechoic mass without invasion into the proper muscle layer (B). After submucosal injection (C), electrosurgical snaring is performed (D). The ulcer bed after endoscopic resection (E). An en-bloc resection was achieved (F).

Figure 2

Ligation-assisted endoscopic mucosal resection for a 10-mm-sized esophageal granular cell tumor. A broad-based, round subepithelial tumor (SET) with whitish-to-yellowish overlying mucosa is detected in the middle esophagus (A). Endoscopic ultrasound (EUS) revealed a hypoechoic mass originating from the submucosa (B). After submucosal injection (C), band-ligation is performed (D). Electrosurgical snaring is performed under the band (E, F). The ulcer bed after endoscopic resection (G). An en-bloc resection was achieved (H).

Figure 3

Cap-assisted endoscopic mucosal resection for a 5-mm-sized esophageal granular cell tumor. A broad-based, round subepithelial tumor (SET) with whitish-to-yellowish overlying mucosa is seen in the lower esophagus (A). After submucosal injection (B), the crescent-shaped snare is positioned on the internal circumferential ridge at the tip of the oblique cap (C). Electrosurgical snaring is performed under the band (D). The ulcer bed after endoscopic resection (E). An en-bloc resection was achieved (F).

Figure 4

Underwater endoscopic mucosal resection for a 6-mm-sized esophageal granular cell tumor. A broad-based, round subepithelial tumor (SET) with whitish-to-yellowish overlying mucosa is seen in the lower esophagus (A). After filling the lumen of the esophagus with distilled water (B), electrosurgical snaring is performed without submucosal injection (C). The ulcer bed after endoscopic resection (D). An en-bloc resection was achieved (E).

Figure 5

Endoscopic submucosal dissection for a 17-mm-sized esophageal granular cell tumor. A broad-based, round subepithelial tumor (SET) with whitish-to-yellowish overlying mucosa is seen in the upper esophagus (A). After submucosal injection, submucosal dissection was performed (B, C). The ulcer bed after endoscopic resection (D). An en-bloc resection was achieved (E).