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Yuki Werner, Thomas Rösch, Hamburg

Sequenzen:

Sequence 1 — esophagogastroduodenoscopy (EGD) with an incidental finding of a submucosal tumor (SMT) in the mid-esophagus

A submucosal tumor was diagnosed in the mid-esophagus as an incidental finding in this patient. The lesion was progressing over time.
Endoscopic ultrasound (EUS) showed that the tumor was 22 mm long and 14 mm wide. Contact with the muscularis could not be definitely excluded.

Sequence 2 — case series for SMTs in the esophagus/cardia using the tunnel technique

In this case, the indication was based on the lesion’s progression, EUS, and the patient’s desire for treatment. In view of the lesion’s size, EUS follow-up would also have been an acceptable alternative.

Sequence 3 — endoscopic resection of the SMT using the tunnel technique: part 1, access

Submucosal injection of a methylene-stained saline solution and incision of the mucosa using the Olympus TT knife.

Sequence 5 — endoscopic resection of the SMT using the tunnel technique: part 3, capsule-protecting tumor dissection

Capsule-protecting tumor dissection and release of the tumor from the muscularis layer.

Sequence 7 — endoscopic resection of the SMT using the tunnel technique: part 5, mobilizing and retrieving the tumor

At the end of the procedure, another switch is made to the Olympus IT Nano Knife to release the tumor from the muscularis.

Sequence 8 — endoscopic resection of the SMT using the tunnel technique: part 6, resection cavity and closure of the channel

Demonstration of the excision area and closure of the mucosal entry site — histology: GIST.

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