Surgical Care

Asymptomatic or smaller lesions should be followed periodically with barium swallow. Surgical excision is recommended for symptomatic leiomyomas and those greater than 5 cm. Consultation with a thoracic surgeon may be beneficial.

Resection is the only way to confirm that a tumor is not malignant. Periodic follow-up of smaller lesions is recommended because leiomyomas have a characteristic radiographic appearance, slow growth rate, and low risk of malignant degeneration. Tumors of the middle third of the esophagus are approached using a right thoracotomy; tumors in the distal third of the esophagus are resected through a left thoracotomy.

The outer esophageal muscle is gently incised longitudinally in order to reveal the lesion. Careful dissection is performed to separate and remove the leiomyoma from the underlying submucosa.

If the mucosa has been opened during dissection, the underlying mucosa is reapproximated, followed by closure of the longitudinal muscle. Some authors have shown that large extramucosal defects may be left open without subsequent complications developing.

Segmental esophageal resection may be indicated for giant leiomyomas of the cardia.

While open surgical technique is the traditional mainstay of therapy for leiomyomas, combined esophagoscopy and video-assisted resection (thoracoscopy), laparoscopic transhiatal resection, and robotic techniques are being increasingly performed.^{[9, 10, 11, 12, 13, 14]}

Tu el al evaluated the safety and efficacy of submucosal tunnel endoscopic resection (STER) for esophageal submucosal tumors. The study involved 115 patients who underwent successful resection for esophageal submucosal tumors (113 cases [95.0%] of leiomyoma) by STER. There were no cases of recurrence and distant metastasis during the mean 15-month follow-up. The investigators concluded STER is a safe and feasible technique for treating esophageal submucosal tumors and that it has advantages over endoscopic submucosal dissection (ESD).^[14]

Following complete surgical resection, no recurrence has ever been reported.

Jiang W, Rice TW, Goldblum JR. Esophageal leiomyoma: experience from a single institution. Dis Esophagus. 2013 Feb-Mar. 26(2):167-74. [QxMD MEDLINE Link].
Wong T, Pattarapuntakul T, Keeratichananont S, Cattapan K, Nirattisaikul S, Wetwittayakhlung P. Multiple esophageal leiomyoma presenting with clinical dysphagia from mechanical obstruction and motility disorder. Case Rep Gastroenterol. 2021 Sep-Dec. 15(3):861-8. [QxMD MEDLINE Link]. [Full Text].
Xu H, Li Y, Wang F, Wang W, Zhang L. Video-assisted thoracoscopic surgery for esophageal leiomyoma: a ten-year single-institution experience. J Laparoendosc Adv Surg Tech A. 2018 Sep. 28(9):1105-8. [QxMD MEDLINE Link].
Mathew G, Osueni A, Carter YM. Esophageal Leiomyoma. StatPearls [Internet]. 2022 Jan. [QxMD MEDLINE Link]. [Full Text].
Gupta V, Lal A, Sinha SK, Nada R, Gupta NM. Leiomyomatosis of the esophagus: experience over a decade. J Gastrointest Surg. 2009 Feb. 13(2):206-11. [QxMD MEDLINE Link].
Choi H, Kim S, Moon JH, et al. Multiple endocrine neoplasia type 1 with multiple leiomyomas linked to a novel mutation in the MEN1 gene. Yonsei Med J. 2008 Aug 30. 49(4):655-61. [QxMD MEDLINE Link]. [Full Text].
Ray S, Saluja SS, Gupta R, Chattopadhyay TK. Esophageal leiomyomatosis -- an unusual cause of pseudoachalasia. Can J Gastroenterol. 2008 Feb. 22(2):187-9. [QxMD MEDLINE Link]. [Full Text].
Xu GQ, Qian JJ, Chen MH, Ren GP, Chen HT. Endoscopic ultrasonography for the diagnosis and selecting treatment of esophageal leiomyoma. J Gastroenterol Hepatol. 2012 Mar. 27(3):521-5. [QxMD MEDLINE Link].
Tomulescu V, Stanescu C, Blajut C, et al. Robotic approach in benign and malignant esophageal tumors; a preliminary seven case series. Chirurgia (Bucur). 2018 Mar-Apr. 113(2):202-9. [QxMD MEDLINE Link]. [Full Text].
Inderhees S, Tank J, Stein HJ, Dubecz A. [Leiomyoma of the esophagus : A further indication for robotic surgery?]. Chirurg. 2019 Feb. 90(2):125-30. [QxMD MEDLINE Link].
Asaf BB, Bishnoi S, Puri HV, Pulle MV, Cerfolio RJ, Kumar A. Robotic enucleation of oesophageal leiomyoma technique and surgical outcomes. J Minim Access Surg. 2022 Jan-Mar. 18(1):84-9. [QxMD MEDLINE Link]. [Full Text].
Andrasi L, Szepes Z, Tiszlavicz L, Lazar G, Paszt A. Complete laparoscopic-transhiatal removal of duplex benign oesophageal tumour: case report and review of literature. BMC Gastroenterol. 2021 Feb 2. 21(1):47. [QxMD MEDLINE Link]. [Full Text].
Daoud A, Beshir H, Abdesalam SI. Right video-assisted thoracoscopic enucleation of an upper thoracic esophageal leiomyoma. Multimed Man Cardiothorac Surg. 2022 Jun 6. 2022:[QxMD MEDLINE Link].
Tu S, Huang S, Li G, et al. Submucosal tunnel endoscopic resection for esophageal submucosal tumors: a multicenter study. Gastroenterol Res Pract. 2018. 2018:2149564. [QxMD MEDLINE Link]. [Full Text].
Wang L, Ren W, Zhang Z, et al. Retrospective study of endoscopic submucosal tunnel dissection (ESTD) for surgical resection of esophageal leiomyoma. Surg Endosc. 2013 Nov. 27(11):4259-66. [QxMD MEDLINE Link].
Bonavina L, Segalin A, Rosati R, Pavanello M, Peracchia A. Surgical therapy of esophageal leiomyoma. J Am Coll Surg. 1995 Sep. 181(3):257-62. [QxMD MEDLINE Link].
Boran C, Sengul N, Balaban YH, Gurel S. Multinodular leiomyoma of the esophagus with internodular hydropic degeneration and bulbous serosal protrusions similar to cotyledonoid uterine leiomyoma. Dis Esophagus. 2007. 20(2):187-9. [QxMD MEDLINE Link].
Chiu PW, Lee YT, Ng EK. Resection of esophageal leiomyoma using an endoscopic submucosal dissection technique. Endoscopy. 2006. 38 Suppl 2:E4. [QxMD MEDLINE Link].
Kent M, d'Amato T, Nordman C, et al. Minimally invasive resection of benign esophageal tumors. J Thorac Cardiovasc Surg. 2007 Jul. 134(1):176-81. [QxMD MEDLINE Link].
Knop S, Schupp M, Wardelmann E, et al. A new case of Carney triad: gastrointestinal stromal tumours and leiomyoma of the oesophagus do not show activating mutations of KIT and platelet-derived growth factor receptor alpha. J Clin Pathol. 2006 Oct. 59(10):1097-9. [QxMD MEDLINE Link].
Memisoglu E, Agarwal B, Akduman I, Prather C, Collins B, Civelek AC. Multimodality diagnostic imaging of diffuse esophageal leiomyomatosis. J Comput Assist Tomogr. 2006 Jan-Feb. 30(1):100-4. [QxMD MEDLINE Link].
Palanivelu C, Rangarajan M, Senthilkumar R, Annapoorni S, Jategaonkar PA. Thoracoscopic management of benign tumors of the mid-esophagus: a retrospective study. Int J Surg. 2007 Oct. 5(5):328-31. [QxMD MEDLINE Link].
Prenzel KL, Schafer E, Stippel D, Beckurts KT, Holscher AH. Multiple giant leiomyomas of the esophagus and stomach. Dis Esophagus. 2006. 19(6):504-8. [QxMD MEDLINE Link].
Zaninotto G, Portale G, Costantini M, et al. Minimally invasive enucleation of esophageal leiomyoma. Surg Endosc. 2006 Dec. 20(12):1904-8. [QxMD MEDLINE Link].

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Kavitha Kumbum, MD Associate Program Director and Attending Physician, Gastroenterology Fellowship Program, Division of Gastroenterology, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine

Kavitha Kumbum, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, New York Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Praveen K Roy, MD, MSc Clinical Assistant Professor of Medicine, University of New Mexico School of Medicine

Praveen K Roy, MD, MSc is a member of the following medical societies: Alaska State Medical Association, American Gastroenterological Association

Disclosure: Nothing to disclose.

Additional Contributors

Maurice A Cerulli, MD, FACP, FACG, FASGE, AGAF Associate Professor of Clinical Medicine, Albert Einstein College of Medicine of Yeshiva University; Associate Professor of Clinical Medicine, Hofstra Medical School

Maurice A Cerulli, MD, FACP, FACG, FASGE, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, New York Society for Gastrointestinal Endoscopy, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Acknowledgements

Simmy Bank, MD Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine

Disclosure: Nothing to disclose.

Anastasios K Konstantakos, MD Clinical Associate Surgeon, Department of Cardiovascular Surgery, Billings Clinic

Disclosure: Nothing to disclose.

Sandeep Mukherjee, MB, BCh, MPH, FRCPC Associate Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center; Consulting Staff, Section of Gastroenterology and Hepatology, Veteran Affairs Medical Center

Disclosure: Merck Honoraria Speaking and teaching; Ikaria Pharmaceuticals Honoraria Board membership

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