Endoscopic resection of giant esophageal leiomyoma by tunelization technique

A submucosal lesion (SML) is a ‘‘bulging’’ covered with normal mucosa found during endoscopy. In general, they are asymptomatic lesions and are considered benign if they are < 2 cm. Conventional management is periodic surveillance and these lesions should be resected only if they begin to grow or cause symptoms. However, there is a risk for malignancy, regardless of size, depending on their histology. Endoscopic ultrasound (EUS) enables the evaluation of their origin with 100% accuracy and has a 78-91% sensitivity in relation to biopsy. Thus, surveillance would cause a delay in diagnosing the malignancy of some SMLs, along with stress for the patients, resulting in a greater need for resection. Resection can be surgical (thoracoscopy or laparoscopy) or endoscopic (ligature, dissection, total endoscopic resection). Surgery implies longer hospital stay and is more expensive than endoscopy, but endoscopy can present with a greater number of complications (perforation, incomplete resection). In 2010 peroral endoscopic myotomy was developed; this technique enables dissection of the muscularis propria of the esophagus in patients with achalasia through a submucosal tunnel with excellent results and minor complications. Recent reports have described good results with this method in the resection of SMLs. Our aim was to communicate the use of this technique in the resection of a giant esophageal SML.