Sub-mucosal Tunneling Endoscopic Resection (STER) of an Esophageal Leiomyoma

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Ricardo Mejia Martinez / Josefina Saez Binelli, Pontificia Universidad Catolica de Chile


Endoscopic and EUS evaluation Endoscopic and EUS evaluation

A two centimeter submucosal lesion arising from muscularis mucosae is identified in the distal esophagus.

Injection Injection

An osmotic agent, consisting in a Voluven based solution with indigo carmine, is injected in the submucosal space at the level in which the mucotomy is planned.

Mucotomy Mucotomy

The needle is exchanged for an endoscopic knife and a longitudinal mucotomy of 15 to 20 mm long is created.

Submucosal tunneling Submucosal tunneling

A submucosal tunnel is created from a point 5 cm proximal to the lesion. It is extended the distally until the tumor is identified, using a combination of blunt dissection and coagulation.

Lesion Resection and Extraction Lesion Resection and Extraction

A pearl-white submucosal tumor is identified during the dissection. The lesion is dissected from the submucosal space and larger feeding vessels are coagulated with coagulation forceps and then sectioned. The distal attachment provides proper traction in order to assist the dissection.

Tunnel Revision Tunnel Revision

Finally, after assuring adequate hemostasis, a gentamicin based solution is instilled into the tunnel.

Mucosal Closure Mucosal Closure

The esophageal mucosa is closed with endoscopic clips starting from the distal end of the defect.

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