Submucosal Tunneling Endoscopic Resection for Submucosal Tumors in the Proximal Esophagus.

BACKGROUND: Submucosal tunneling endoscopic resection (STER) is widely applied for treatment of gastrointestinal submucosal tumors (SMTs) originating from the muscularis propria layer. However, the tumor location within the proximal esophagus makes STER a challenge for the endoscopists. The aim of this study was to summarize the technique skill and evaluate the outcomes of proximal esophageal STER. STUDY DESIGN: A total of 72 patients with SMTs in the proximal esophagus undergoing STER were included from February 2019 to March 2021. Imaging 3-dimensional reconstruction was used for patients with large SMTs. Clinicopathological, endoscopic, and follow-up data were collected and analyzed. RESULTS: In this study, all the tumors were removed completely and no gross disease was remaining. The en bloc resection was achieved in 90.28% of patients, and the complications rate was 6.95%. Three-dimensional reconstruction was used for 30 patients (41.67%) with large SMTs (transverse diameter >2.0 cm). Based on statistical analysis, tumors with irregular shape and larger size were the significant contributors to piecemeal resection. Larger tumors increase the risk of long operation time, and irregular tumor shapes increase the risk of complications. The median hospitalization time was 4 days. All of the complications were cured by conservative treatment. A median follow-up of 12 months was available, and all patients were free from local recurrence or distant metastasis during the study period. CONCLUSIONS: STER is an effective and safe methodology for the resection of proximal esophageal SMTs. Tumor size and shape mainly impact the piecemeal resection rate, STER-related complications, and procedural difficulty.

Endoscopic retrieval of an 18-cm long chopstick embedded for ten months post-automutilation in the esophagus of a patient with psychosis.

Foreign body ingestion is an emergency or acute situation that commonly occurs in children or adults and involves the ingestion of one or more objects. Moreover, once the discovery of swallowed foreign bodies has been made, families are typically very anxious to have the patient see a doctor. If the foreign object becomes embedded in the digestive tract, it must be removed; in emergencies, this is done by endoscopy or surgery. This case report presents the successful endoscopic retrieval of a chopstick with both sides embedded 4 cm into the esophageal wall for > 10 mo in a male patient following automutilation in an attempt to be released from a psychiatric hospital. Hot hemostatic forceps were used to open the distal esophageal mucosa in which the chopstick was embedded. The procedure was performed under intravenous general anesthesia and took approximately 7 h.