Clinical Outcomes of Minimally Invasive Enucleation of Leiomyoma of the Esophagus and Esophagogastric Junction

Abstract

Objective

Minimally invasive enucleation is the treatment of choice in symptomatic patients with esophageal leiomyoma. Comprehensive long-term follow-up data are lacking. Aim of this study was to review the clinical outcomes of three procedures for enucleation of leiomyoma of the esophagus and esophagogastric junction.

Methods

A single institution retrospective review was performed using a prospectively collected research database and individual medical records. Demographics, presenting symptoms, use of proton-pump inhibitors (PPI), tumor location and size, treatment modalities, and subjective and objective clinical outcomes were recorded. Barium swallow and upper gastrointestinal endoscopy were routinely performed during the follow-up. Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) and Short-Form 36 questionnaires were used to compare quality of life before and after treatment.

Results

Between 2002 and 2017, 35 patients underwent minimally invasive leiomyoma enucleation through thoracoscopy (n = 15), laparoscopy (n = 15), and endoscopy (n = 5). The overall morbidity rate was 14.3% and there was no mortality. All patients had a minimum of 1-year follow-up. The median follow-up was 49 (IQR 54) months, and there were no recurrences of leiomyoma. At the latest follow-up, the SF-36 scores were unchanged compared to baseline. However, there was a higher incidence of reflux symptoms (p < 0.050) and PPI use (p < 0.050) after endoscopic treatment.

Conclusions

Minimally invasive enucleation is safe and effective and can be performed by a variety of approaches according to leiomyoma location and morphology. Overall, health-related quality of life outcomes of each procedure appear satisfactory, but PPI dependence was greater in the endoscopic group.

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References

  1. 1.

    Plachta A. Benign tumors of the esophagus: review of the literature and report of 99 cases. Am J Gastroenterol 1962; 38: 639–652

    CAS  PubMed  Google Scholar 

  2. 2.

    Seremetis MG, Lyons WS, deGuzman VC, Peabody JW. Leiomyomata of the esophagus. An analysis of 838 cases. Cancer 1976;38:2166–77

    CAS  Article  Google Scholar 

  3. 3.

    Codipilly DC, Fang H, Alexander JA, Katzka DA, Ravi K. Subepithelial esophageal tumors: a single-center review of resected and surveilled lesions. Gastrointest Endosc 2018;87:370–77

    Article  Google Scholar 

  4. 4.

    Dumonceau JM, Polkowski M, Larghi A, Vilmann P, Giovannini M, Frossard JL, et al. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy 2011;43:897–909

    Article  Google Scholar 

  5. 5.

    Mutrie CJ, Donahue DM, Wain JC, Wright CD, Gaissert HA, Grillo HC, et al. Esophageal leiomyomata: a 40-year experience. Ann Thorac Surg 2005;79: 1122–1125

    Article  Google Scholar 

  6. 6.

    Bonavina L, Segalin A, Rosati R, Pavanello M, Peracchia A. Surgical therapy of esophageal leiomyoma. J Am Coll Surg 1995;181: 257–262

    CAS  PubMed  Google Scholar 

  7. 7.

    Lee LS, Singhal S, Brinster CJ, Marshall B, Kochman ML, Kaiser LR, et al. Current management of esophageal leiomyoma. J Am Coll Surg 2004;198:136–146

    Article  Google Scholar 

  8. 8.

    Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013 Mar;108(3):308–28

    Article  Google Scholar 

  9. 9.

    Lovece A, Milito P, Asti E, Bonavina L. Giant oesophageal leiomyoma causing severe hypertension. BMJ Case Rep. 2016;13;2016

    Google Scholar 

  10. 10.

    Shin S, Choi YS, Shim YM, et al. Enucleation of esophageal submucosal tumors: a single institution's experience. Ann Thorac Surg. 2014;97(2):454–9

    Article  Google Scholar 

  11. 11.

    Jiang W, Rice TW, Goldblum JR. Esophageal leiomyoma: experience from a single institution. Dis Esoph 2013;26:167–74

    CAS  Article  Google Scholar 

  12. 12.

    Cheng BC, Chang S, Mao ZH, Li MJ, Huang J, Wang ZW, et al. Surgical treatment of giant esophageal leiomyoma. World J Gastroenterol 2005;11:4258–60

    Article  Google Scholar 

  13. 13.

    Ohsawa T. Surgery of the esophagus. Arch Jpn Chir 1933;10:605–60

    Google Scholar 

  14. 14.

    Everitt NJ, Glinatsis M, McMahon MJ. Thoracoscopic enucleation of leiomyoma of the oesophagus. Br J Surg 1992;79:643

    CAS  Article  Google Scholar 

  15. 15.

    Bardini R, Segalin A, Ruol A, Pavanello M, Peracchia A. Videothoracoscopic enucleation of esophageal leiomyoma. Ann Thorac Surg 1992;54:576–7

    CAS  Article  Google Scholar 

  16. 16.

    Bonavina L, Laface L, Abate E, Punturieri M, Agosteo E, Nencioni M. Comparison of ventilation and cardiovascular parameters between prone thoracoscopic and Ivor Lewis esophagectomy. Updates Surg. 2012;64(2):81–5

    Article  Google Scholar 

  17. 17.

    Zaninotto G, Portale G, Costantini M, Rizzetto C, Salvador R, Rampado S, et al. Minimally invasive enucleation of esophageal leiomyoma. Surg Endosc. 2006;20(12):1904–8

    CAS  Article  Google Scholar 

  18. 18.

    Kent M, d’Amato T, Nordman C, Schuchert M, Landreneau R, Alvelo-Rivera M, et al. Minimally invasive resection of benign esophageal tumors. J Thorac Cardiovasc Surg 2007;134:176–181

    Article  Google Scholar 

  19. 19.

    Palanivelu C, Rangarajan M, Parthasarathi R, Senthikumar R. Laparoscopic transhiatal approach for benign supradiaphragmatic lesions of the esophagus: a replacement for thoracoscopy? Dis Esoph 2008;21:176–180

    CAS  Article  Google Scholar 

  20. 20.

    Jeon HW, Choi MG, Lim CH, Park JK, Sung SW. Intraoperative esophagoscopy provides accuracy and safety in video-assisted thoracoscopic enucleation of benign esophageal submucosal tumors. Dis Esoph 2015;28:437–441

    CAS  Article  Google Scholar 

  21. 21.

    Siboni S, Bona D, Abate E, Bonavina L. Tension pneumoperitoneum following endoscopic submucosal dissection of leiomyoma of the cardia. Endoscopy 2010;42 S2:E152

    Article  Google Scholar 

  22. 22.

    Bona D, Aiolfi A, Siboni S, Bernardi D, Bonavina L. Giant leiomyoma of the gastroesophageal junction: technique and results of endoscopic full-thickness resection. Clin Exp Gastroenterol 2011;4:263–7

    Article  Google Scholar 

  23. 23.

    Park YS, Park SW, Kim T, Song SI, Choi EH, Chung JB. Endoscopic enucleation of upper-GI submucosal tumors by using an insulated-tip electrosurgical knife. Gastrointest Endosc 2004;59:409–415

    Article  Google Scholar 

  24. 24.

    Inoue H, Ikeda H, Hosoya T, Onimaru M, Yoshida A, Eleftheriadis N, et al. Submucosal endoscopic tumor resection for subepithelial tumors in the esophagus and cardia. Endoscopy 2012;44:225–230

    CAS  Article  Google Scholar 

  25. 25.

    Li Q, Meng Y, Xu Y, Zhang Q, Cai J, Zheng H, et al. Comparison of endoscopic submucosal tunneling dissection and thoracoscopic enucleation for the treatment of esophageal submucosal tumors. Gastrointest Endosc 2017;86:485–491

    Article  Google Scholar 

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All authors met the following criteria as per ICMJE guidelines:

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Correspondence to Luigi Bonavina.

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Milito, P., Asti, E., Aiolfi, A. et al. Clinical Outcomes of Minimally Invasive Enucleation of Leiomyoma of the Esophagus and Esophagogastric Junction. J Gastrointest Surg 24, 499–504 (2020). https://doi.org/10.1007/s11605-019-04210-3

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Keywords

  • Leiomyoma
  • Benign esophageal tumors
  • Endoscopic ultrasonography
  • Thoracoscopy
  • Laparoscopy
  • Enucleation
  • Endoscopic submucosal dissection
  • Gastroesophageal reflux disease