VideoGIE
Endoscopic submucosal dissection for symptomatic esophageal cavernous hemangioma
Figure 1. A, Endoscopic image of esophageal submucosal lesion. B, EUS image demonstrating no blood flow through the lesion.
A 54-year-old man presented to our institution with severe dysphagia. Gastroscopy revealed a 10-mm submucosal lesion, with a blue tinge, in the esophagus, 30 cm from the incisors (Fig. 1A). An EUS demonstrated a 10-mm, predominantly fat, hypoechoic, submucosal lesion extending to, but not infiltrating, the muscularis propria. Color Doppler did not identify blood flow through the lesion (Fig. 1B). Endoscopic follow-up was recommended. During follow-up the patient described having progressive dysphagia and odynophagia. Management options of surgery, endoscopic resection, and endoscopic follow-up were discussed. Endoscopic submucosal dissection (ESD) was performed to resect the lesion (Video 1, available online at www.giejournal. org). The procedure was successfully completed without any significant adverse events. The resection specimen showed benign squamous mucosa with an
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store.
998 GASTROINTESTINAL ENDOSCOPY Volume 81, No. 4 : 2015
ectatic blood vessel, in keeping with a benign cavernous hemangioma. At follow-up, the patient’s symptoms have improved. The use of ESD of vascular lesions in the esophagus is high risk. However, if the correct submucosal plane is identified, large blood vessels can be avoided. In this case, it became apparent to us at a very early stage that it was a vascular lesion, so dissection was performed in the deeper planes. This case demonstrates the successful treatment of an esophageal submucosal cavernous hemangioma by ESD, avoiding the morbidity associated with esophagectomy. DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Fergus J. Q. Chedgy, MBBS, BSc, MRCP, Rupam Bhattacharyya, MBBS, MRCP, Pradeep Bhandari, MBBS, MD, MRCP, Queen Alexandra Hospital, Portsmouth, Hampshire, UK
http://dx.doi.org/10.1016/j.gie.2014.10.023
www.giejournal.org
Endoscopic submucosal dissection for symptomatic esophageal cavernous hemangioma
Figure 1. A, Endoscopic image of esophageal submucosal lesion. B, EUS image demonstrating no blood flow through the lesion.
A 54-year-old man presented to our institution with severe dysphagia. Gastroscopy revealed a 10-mm submucosal lesion, with a blue tinge, in the esophagus, 30 cm from the incisors (Fig. 1A). An EUS demonstrated a 10-mm, predominantly fat, hypoechoic, submucosal lesion extending to, but not infiltrating, the muscularis propria. Color Doppler did not identify blood flow through the lesion (Fig. 1B). Endoscopic follow-up was recommended. During follow-up the patient described having progressive dysphagia and odynophagia. Management options of surgery, endoscopic resection, and endoscopic follow-up were discussed. Endoscopic submucosal dissection (ESD) was performed to resect the lesion (Video 1, available online at www.giejournal. org). The procedure was successfully completed without any significant adverse events. The resection specimen showed benign squamous mucosa with an
This video can be viewed directly from the GIE website or by using the QR code and your mobile device. Download a free QR code scanner by searching “QR Scanner” in your mobile device’s app store.
998 GASTROINTESTINAL ENDOSCOPY Volume 81, No. 4 : 2015
ectatic blood vessel, in keeping with a benign cavernous hemangioma. At follow-up, the patient’s symptoms have improved. The use of ESD of vascular lesions in the esophagus is high risk. However, if the correct submucosal plane is identified, large blood vessels can be avoided. In this case, it became apparent to us at a very early stage that it was a vascular lesion, so dissection was performed in the deeper planes. This case demonstrates the successful treatment of an esophageal submucosal cavernous hemangioma by ESD, avoiding the morbidity associated with esophagectomy. DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Fergus J. Q. Chedgy, MBBS, BSc, MRCP, Rupam Bhattacharyya, MBBS, MRCP, Pradeep Bhandari, MBBS, MD, MRCP, Queen Alexandra Hospital, Portsmouth, Hampshire, UK
http://dx.doi.org/10.1016/j.gie.2014.10.023
www.giejournal.org
