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Esophageal insufflation computed tomography for the diagnosis and management of esophageal submucosal tumors

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Abstract

Background

The selection of therapy for benign esophageal lesions depends in part on whether the lesion extends to or through the esophageal muscle wall. The advent of endoscopic dissection of deep lesions has made this distinction important in the choice between different forms of advanced endoscopic therapy. The goal of this study was to evaluate esophageal insufflation computed tomography (EICT) for the diagnosis and management of esophageal submucosal tumors (SMTs).

Methods

Between April 2011 and May 2013 at the Second Affiliated Hospital of Harbin Medical University, 27 patients with esophageal SMTs diagnosed by gastroscopy were studied observationally. Entry criteria included tumors larger than 0.5 cm. We compared endoscopic ultrasound (EUS) and EICT to assess lesion depth and the relationship between the submucosal lesion and the esophageal wall using the resected lesion as the gold standard.

Results

Twenty-seven esophageal SMTs were evaluated. EUS and EICT accurately identified nine as superficial to the muscularis propria. EICT correctly identified the relation of the tumor extension and the outer esophageal wall in all 18 lesions that originated from the muscularis propria; only nine were correctly assessed by EUS (P < 0.001).

Conclusions

EICT enables improved judgment of the relation of esophageal lesions and the esophageal-mediastinal border. We propose EICT as a new, safe, effective, useful, simple and high-tolerance method for assessing the depth and relationships of esophageal submucosal lesions.

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Acknowledgments

We express our gratitude to Professor David Y. Graham for his assistance in revising the manuscript and Miss Shui Liu for her assistance in drawing Fig. 1.

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    Authors and Affiliations

    1. Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, Heilongjiang Province, China

      Bing-Rong Liu, Xin-Hong Wang, Lei Zhan, Ji-Tao Song, Bing Du, Lin Cui & Su-Qin Liu

    2. Department of Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China

      Bai-Lu Liu & Li-Li Liu

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    1. Bing-Rong Liu
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    Bing-Rong Liu, Bai-Lu Liu, Xin-Hong Wang, Lei Zhan, Li-Li Liu, Ji-Tao Song, Bing Du, Lin Cui and Su-Qin Liu have no conflicts of interest or financial ties to disclose.

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    Bing-Rong Liu, Bai-Lu Liu and Xin-Hong Wang have contributed equally to this work.

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    Liu, BR., Liu, BL., Wang, XH. et al. Esophageal insufflation computed tomography for the diagnosis and management of esophageal submucosal tumors. Surg Endosc 31, 2350–2355 (2017). https://doi.org/10.1007/s00464-016-5220-3

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