Esophageal Leiomyoma Treatment & Management

Updated: Jan 25, 2023
  • Author: Kavitha Kumbum, MD; Chief Editor: Praveen K Roy, MD, MSc  more...
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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.