Piecemeal submucosal tunneling endoscopic resection of a 4-cm esophageal leiomyoma.

Background and Aims: Leiomyomas are the most common benign neoplasm of the esophagus. Although typically asymptomatic, they can cause retrosternal discomfort and dysphagia. Submucosal tunneling endoscopic resection (STER) has been increasingly used for resecting esophageal subepithelial lesions. We present this case of STER for resection of a 4-cm esophageal leiomyoma. Methods: A 44-year-old man presenting with retrosternal discomfort, dysphagia, and heartburn was found on EGD to have a 4-cm subepithelial lesion in the mid esophagus. Subsequent endoscopic ultrasound and fine-needle biopsy confirmed this as a leiomyoma on pathology. STER was performed, which involved making a mucosotomy 4 cm proximal to the lesion, creating a submucosal tunnel, and removing the lesion in a piecemeal fashion. The patient developed transient hypoxia lasting 1 to 2 minutes, with chest x-ray showing intraprocedural pneumothorax, which spontaneously resolved at the end of the case. He was admitted for observation and discharged in stable condition after 2 days. He was doing well at follow-up. Results: The patient had a successful piecemeal removal of a 4-cm esophageal leiomyoma using the STER technique. Conclusions: STER is a viable, minimally invasive method for removing leiomyomas and other subepithelial lesions from the esophagus.