Use of tunnel endoscopy for diagnosis of obscure submucosal esophageal adenocarcinoma:A case report and review of the literature with emphasis on causes of esophageal stenosis
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摘要
BACKGROUND The tunnel endoscopic technique is the treatment of choice for submucosal tumors. However, the use of tunnel endoscopy to diagnose adenocarcinoma of the esophagus originating from the submucosa has not been well studied.CASE SUMMARY A 74-year-old man who presented with dysphagia for half a year underwent a series of checks, such as gastroendoscopy, X-ray contrast examination of the upper digestive tract, endoscopic ultrasonography, high-resolution esophageal manometry, and positron emission computed tomography. It should be noted that the stenosis of the esophagus was too narrow for endoscopic ultrasoundguided fine needle aspiration. The cause remained undiagnosed. Eventually, the tunnel endoscopic technique was perform for the pathological examination in the submucosa and the final diagnosis was adenocarcinoma of the esophagus. The patient and family members chose expectant treatment due to the patient's age and the high costs of surgical treatment.CONCLUSION Tunnel endoscopy could be used to diagnose tumors. Moreover, we review the literature to provide guidance regarding the causes of esophagostenosis.
BACKGROUND The tunnel endoscopic technique is the treatment of choice for submucosal tumors. However, the use of tunnel endoscopy to diagnose adenocarcinoma of the esophagus originating from the submucosa has not been well studied.CASE SUMMARY A 74-year-old man who presented with dysphagia for half a year underwent a series of checks, such as gastroendoscopy, X-ray contrast examination of the upper digestive tract, endoscopic ultrasonography, high-resolution esophageal manometry, and positron emission computed tomography. It should be noted that the stenosis of the esophagus was too narrow for endoscopic ultrasoundguided fine needle aspiration. The cause remained undiagnosed. Eventually, the tunnel endoscopic technique was perform for the pathological examination in the submucosa and the final diagnosis was adenocarcinoma of the esophagus. The patient and family members chose expectant treatment due to the patient's age and the high costs of surgical treatment.CONCLUSION Tunnel endoscopy could be used to diagnose tumors. Moreover, we review the literature to provide guidance regarding the causes of esophagostenosis.
BACKGROUND The tunnel endoscopic technique is the treatment of choice for submucosal tumors. However, the use of tunnel endoscopy to diagnose adenocarcinoma of the esophagus originating from the submucosa has not been well studied.CASE SUMMARY A 74-year-old man who presented with dysphagia for half a year underwent a series of checks, such as gastroendoscopy, X-ray contrast examination of the upper digestive tract, endoscopic ultrasonography, high-resolution esophageal manometry, and positron emission computed tomography. It should be noted that the stenosis of the esophagus was too narrow for endoscopic ultrasoundguided fine needle aspiration. The cause remained undiagnosed. Eventually, the tunnel endoscopic technique was perform for the pathological examination in the submucosa and the final diagnosis was adenocarcinoma of the esophagus. The patient and family members chose expectant treatment due to the patient's age and the high costs of surgical treatment.CONCLUSION Tunnel endoscopy could be used to diagnose tumors. Moreover, we review the literature to provide guidance regarding the causes of esophagostenosis.
引文
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2 Shibata A,Matsuda T,Ajiki W,Sobue T.Trend in incidence of adenocarcinoma of the esophagus in Japan,1993-2001.Jpn J Clin Oncol 2008;38:464-468[PMID:18664481 DOI:10.1093/jjco/hyn064]
3 Ajani JA,D'Amico TA,Almhanna K,Bentrem DJ,Besh S,Chao J,Das P,Denlinger C,Fanta P,Fuchs CS,Gerdes H,Glasgow RE,Hayman JA,Hochwald S,Hofstetter WL,Ilson DH,Jaroszewski D,Jasperson K,Keswani RN,Kleinberg LR,Korn WM,Leong S,Lockhart AC,Mulcahy MF,Orringer MB,Posey JA,Poultsides GA,Sasson AR,Scott WJ,Strong VE,Varghese TK,Washington MK,Willett CG,Wright CD,Zelman D,McMillian N,Sundar H;National comprehensive cancer network.Esophageal and esophagogastric junction cancers,version 1.2015.J Natl Compr Canc Netw 2015;13:194-227[PMID:25691612 DOI:10.6004/jnccn.2015.0028]
4 Enzinger PC,Mayer RJ.Esophageal cancer.N Engl J Med 2003;349:2241-2252[PMID:14657432 DOI:10.1056/NEJMra035010]
5 Xu MD,Cai MY,Zhou PH,Qin XY,Zhong YS,Chen WF,Hu JW,Zhang YQ,Ma LL,Qin WZ,Yao LQ.Submucosal tunneling endoscopic resection:a new technique for treating upper GI submucosal tumors originating from the muscularis propria layer(with videos).Gastrointest Endosc 2012;75:195-199[PMID:22056087 DOI:10.1016/j.gie.2011.08.018]
6 Fan YJ,Song X,Li JL,Li XM,Liu B,Wang R,Fan ZM,Wang LD.Esophageal and gastric cardia cancers on 4238 Chinese patients residing in municipal and rural regions:a histopathological comparison during 24-year period.World J Surg 2008;32:1980-1988[PMID:18566857 DOI:10.1007/s00268-008-9674-x]
7 Borghesi S,Hawkins MA,Tait D.Oesophagectomy after definitive chemoradiation in patients with locally advanced oesophageal cancer.Clin Oncol(R Coll Radiol)2008;20:221-226[PMID:18248970DOI:10.1016/j.clon.2007.12.001]
8 Ramage JI,Rumalla A,Baron TH,Pochron NL,Zinsmeister AR,Murray JA,Norton ID,Diehl N,Romero Y.A prospective,randomized,double-blind,placebo-controlled trial of endoscopic steroid injection therapy for recalcitrant esophageal peptic strictures.Am J Gastroenterol 2005;100:2419-2425[PMID:16279894 DOI:10.1111/j.1572-0241.2005.00331.x]
9 Muir AB,Wang JX,Nakagawa H.Epithelial-stromal crosstalk and fibrosis in eosinophilic esophagitis.JGastroenterol 2019;54:10-18[PMID:30101408 DOI:10.1007/s00535-018-1498-3]
10 Moonen A,Boeckxstaens G.Current diagnosis and management of achalasia.J Clin Gastroenterol 2014;48:484-490[PMID:24926623 DOI:10.1097/MCG.0000000000000137]
11 Yeoh SW.Esophageal bezoar due to karaya gum granules used as a laxative.Clin J Gastroenterol 2017;10:437-441[PMID:28730320 DOI:10.1007/s12328-017-0764-x]
12 He K,Zhao L,Bu S,Liu L,Wang X,Wang M,Fan Z.Endoscopic mucosal autograft for treating esophageal caustic strictures:preliminary human experience.Endoscopy 2018;50:1017-1021[PMID:29890517 DOI:10.1055/a-0622-8019]
13 Siddiqui AA,Sarkar A,Beltz S,Lewis J,Loren D,Kowalski T,Fang J,Hilden K,Adler DG.Placement of fully covered self-expandable metal stents in patients with locally advanced esophageal cancer before neoadjuvant therapy.Gastrointest Endosc 2012;76:44-51[PMID:22726465 DOI:10.1016/j.gie.2012.02.036]
14 Nandy N,Gavin M,Martin D,McCarthy D.Crohn's Disease:Hard to Swallow!Dig Dis Sci 2017;62:2690-2693[PMID:28884257 DOI:10.1007/s10620-017-4751-3]
15 Obiorah I,Hussain A,Palese C,Azumi N,Benjamin S,Ozdemirli M.IgG4-related disease involving the esophagus:a clinicopathological study.Dis Esophagus 2017;30:1-7[PMID:28881885 DOI:10.1093/dote/dox091]
16 Agarwalla A,Small AJ,Mendelson AH,Scott FI,Kochman ML.Risk of recurrent or refractory strictures and outcome of endoscopic dilation for radiation-induced esophageal strictures.Surg Endosc 2015;29:1903-1912[PMID:25277484 DOI:10.1007/s00464-014-3883-1]
17 Abbes L,Perrod G,Rahmi G,Cellier C.Esophageal intramural pseudodiverticulosis,a rare cause of stenosis.Clin Res Hepatol Gastroenterol 2017;41:505-506[PMID:28506454 DOI:10.1016/j.clinre.2017.04.001]
18 Michalak A,Cicho?-Lach H,Prozorow-Król B,Buk L,Dzida M.A rare case of skin blistering and esophageal stenosis in the course of epidermolysis bullosa-case report and literature review.BMCGastroenterol 2018;18:47[PMID:29653516 DOI:10.1186/s12876-018-0771-5]
19 Soh JS,Kim JK,Lim H,Kang HS,Park JW,Kim SE,Moon SH,Kim JH,Park CK,Cho JW,Lim MS,Kim KO.Comparison of endoscopic submucosal dissection and surgical resection for treating gastric subepithelial tumours.Scand J Gastroenterol 2016;51:633-638[PMID:26673033 DOI:10.3109/00365521.2015.1124451]
20 He G,Wang J,Chen B,Xing X,Wang J,Chen J,He Y,Cui Y,Chen M.Feasibility of endoscopic submucosal dissection for upper gastrointestinal submucosal tumors treatment and value of endoscopic ultrasonography in pre-operation assess and post-operation follow-up:a prospective study of 224 cases in a single medical center.Surg Endosc 2016;30:4206-4213[PMID:26823060 DOI:10.1007/s00464-015-4729-1]
21 Shen C,Chen H,Yin Y,Chen J,Han L,Zhang B,Chen Z,Chen J.Endoscopic versus open resection for small gastric gastrointestinal stromal tumors:safety and outcomes.Medicine(Baltimore)2015;94:e376[PMID:25569663 DOI:10.1097/MD.0000000000000376]
2 Shibata A,Matsuda T,Ajiki W,Sobue T.Trend in incidence of adenocarcinoma of the esophagus in Japan,1993-2001.Jpn J Clin Oncol 2008;38:464-468[PMID:18664481 DOI:10.1093/jjco/hyn064]
3 Ajani JA,D'Amico TA,Almhanna K,Bentrem DJ,Besh S,Chao J,Das P,Denlinger C,Fanta P,Fuchs CS,Gerdes H,Glasgow RE,Hayman JA,Hochwald S,Hofstetter WL,Ilson DH,Jaroszewski D,Jasperson K,Keswani RN,Kleinberg LR,Korn WM,Leong S,Lockhart AC,Mulcahy MF,Orringer MB,Posey JA,Poultsides GA,Sasson AR,Scott WJ,Strong VE,Varghese TK,Washington MK,Willett CG,Wright CD,Zelman D,McMillian N,Sundar H;National comprehensive cancer network.Esophageal and esophagogastric junction cancers,version 1.2015.J Natl Compr Canc Netw 2015;13:194-227[PMID:25691612 DOI:10.6004/jnccn.2015.0028]
4 Enzinger PC,Mayer RJ.Esophageal cancer.N Engl J Med 2003;349:2241-2252[PMID:14657432 DOI:10.1056/NEJMra035010]
5 Xu MD,Cai MY,Zhou PH,Qin XY,Zhong YS,Chen WF,Hu JW,Zhang YQ,Ma LL,Qin WZ,Yao LQ.Submucosal tunneling endoscopic resection:a new technique for treating upper GI submucosal tumors originating from the muscularis propria layer(with videos).Gastrointest Endosc 2012;75:195-199[PMID:22056087 DOI:10.1016/j.gie.2011.08.018]
6 Fan YJ,Song X,Li JL,Li XM,Liu B,Wang R,Fan ZM,Wang LD.Esophageal and gastric cardia cancers on 4238 Chinese patients residing in municipal and rural regions:a histopathological comparison during 24-year period.World J Surg 2008;32:1980-1988[PMID:18566857 DOI:10.1007/s00268-008-9674-x]
7 Borghesi S,Hawkins MA,Tait D.Oesophagectomy after definitive chemoradiation in patients with locally advanced oesophageal cancer.Clin Oncol(R Coll Radiol)2008;20:221-226[PMID:18248970DOI:10.1016/j.clon.2007.12.001]
8 Ramage JI,Rumalla A,Baron TH,Pochron NL,Zinsmeister AR,Murray JA,Norton ID,Diehl N,Romero Y.A prospective,randomized,double-blind,placebo-controlled trial of endoscopic steroid injection therapy for recalcitrant esophageal peptic strictures.Am J Gastroenterol 2005;100:2419-2425[PMID:16279894 DOI:10.1111/j.1572-0241.2005.00331.x]
9 Muir AB,Wang JX,Nakagawa H.Epithelial-stromal crosstalk and fibrosis in eosinophilic esophagitis.JGastroenterol 2019;54:10-18[PMID:30101408 DOI:10.1007/s00535-018-1498-3]
10 Moonen A,Boeckxstaens G.Current diagnosis and management of achalasia.J Clin Gastroenterol 2014;48:484-490[PMID:24926623 DOI:10.1097/MCG.0000000000000137]
11 Yeoh SW.Esophageal bezoar due to karaya gum granules used as a laxative.Clin J Gastroenterol 2017;10:437-441[PMID:28730320 DOI:10.1007/s12328-017-0764-x]
12 He K,Zhao L,Bu S,Liu L,Wang X,Wang M,Fan Z.Endoscopic mucosal autograft for treating esophageal caustic strictures:preliminary human experience.Endoscopy 2018;50:1017-1021[PMID:29890517 DOI:10.1055/a-0622-8019]
13 Siddiqui AA,Sarkar A,Beltz S,Lewis J,Loren D,Kowalski T,Fang J,Hilden K,Adler DG.Placement of fully covered self-expandable metal stents in patients with locally advanced esophageal cancer before neoadjuvant therapy.Gastrointest Endosc 2012;76:44-51[PMID:22726465 DOI:10.1016/j.gie.2012.02.036]
14 Nandy N,Gavin M,Martin D,McCarthy D.Crohn's Disease:Hard to Swallow!Dig Dis Sci 2017;62:2690-2693[PMID:28884257 DOI:10.1007/s10620-017-4751-3]
15 Obiorah I,Hussain A,Palese C,Azumi N,Benjamin S,Ozdemirli M.IgG4-related disease involving the esophagus:a clinicopathological study.Dis Esophagus 2017;30:1-7[PMID:28881885 DOI:10.1093/dote/dox091]
16 Agarwalla A,Small AJ,Mendelson AH,Scott FI,Kochman ML.Risk of recurrent or refractory strictures and outcome of endoscopic dilation for radiation-induced esophageal strictures.Surg Endosc 2015;29:1903-1912[PMID:25277484 DOI:10.1007/s00464-014-3883-1]
17 Abbes L,Perrod G,Rahmi G,Cellier C.Esophageal intramural pseudodiverticulosis,a rare cause of stenosis.Clin Res Hepatol Gastroenterol 2017;41:505-506[PMID:28506454 DOI:10.1016/j.clinre.2017.04.001]
18 Michalak A,Cicho?-Lach H,Prozorow-Król B,Buk L,Dzida M.A rare case of skin blistering and esophageal stenosis in the course of epidermolysis bullosa-case report and literature review.BMCGastroenterol 2018;18:47[PMID:29653516 DOI:10.1186/s12876-018-0771-5]
19 Soh JS,Kim JK,Lim H,Kang HS,Park JW,Kim SE,Moon SH,Kim JH,Park CK,Cho JW,Lim MS,Kim KO.Comparison of endoscopic submucosal dissection and surgical resection for treating gastric subepithelial tumours.Scand J Gastroenterol 2016;51:633-638[PMID:26673033 DOI:10.3109/00365521.2015.1124451]
20 He G,Wang J,Chen B,Xing X,Wang J,Chen J,He Y,Cui Y,Chen M.Feasibility of endoscopic submucosal dissection for upper gastrointestinal submucosal tumors treatment and value of endoscopic ultrasonography in pre-operation assess and post-operation follow-up:a prospective study of 224 cases in a single medical center.Surg Endosc 2016;30:4206-4213[PMID:26823060 DOI:10.1007/s00464-015-4729-1]
21 Shen C,Chen H,Yin Y,Chen J,Han L,Zhang B,Chen Z,Chen J.Endoscopic versus open resection for small gastric gastrointestinal stromal tumors:safety and outcomes.Medicine(Baltimore)2015;94:e376[PMID:25569663 DOI:10.1097/MD.0000000000000376]