Slicing Through the Options: A Systematic Review of Esophageal Leiomyoma Management.

IF 1 Q3 MEDICINE, GENERAL & INTERNAL
Cureus Pub Date : 2025-04-02 eCollection Date: 2025-04-01 DOI:10.7759/cureus.81614
Shelleen Gowrie, Anniesha Noel, Candace Wooten, Jennifer Powel, Jerzy Gielecki, Anna Zurada, Michael Montalbano, Marios Loukas
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Abstract

Esophageal leiomyomas are rare, benign tumors that can remain asymptomatic or cause dysphagia and chest discomfort when they grow large. Despite advancements in diagnostic and therapeutic strategies, optimal management remains debated. This systematic review evaluates current diagnostic modalities and treatment approaches, synthesizing findings from a comprehensive PubMed search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 51 studies were included, comprising six original studies, 26 case reports, nine retrospective cohort studies, nine case series, and two cross-sectional studies. Findings indicate that endoscopic ultrasonography (EUS) is the most accurate diagnostic tool (89% accuracy), while computed tomography (CT) and barium swallow studies provide complementary structural assessments. Immunohistochemical staining differentiates leiomyomas from gastrointestinal stromal tumors (GISTs), with leiomyomas expressing desmin and smooth muscle actin (SMA) but lacking CD34 and KIT. Surgical intervention is recommended for symptomatic tumors or those exceeding 5 cm. Minimally invasive techniques, including robotic-assisted thoracoscopic surgery (RATS) and submucosal tunneling endoscopic resection (STER), offer superior outcomes compared to traditional open surgery. RATS demonstrates a negligible mucosal injury rate versus 1-15% for other approaches, while STER minimizes blood loss and accelerates recovery. Postoperative outcomes are generally favorable, though transient gastroesophageal reflux disease (GERD) is the most common complication. While STER and RATS present effective alternatives with reduced morbidity, this review highlights limitations, including variability in study designs, small sample sizes, and a lack of long-term follow-up data. Further prospective studies are needed to optimize patient selection and establish long-term efficacy. This review provides insights to inform clinical practice and guide future research in the management of esophageal leiomyomas.

切开选择:食管平滑肌瘤治疗的系统回顾。
食管平滑肌瘤是一种罕见的良性肿瘤,当它变大时,可以保持无症状或引起吞咽困难和胸部不适。尽管诊断和治疗策略取得了进步,但最佳管理仍然存在争议。本系统综述评估了当前的诊断模式和治疗方法,并根据系统综述和荟萃分析(PRISMA)指南的首选报告项目,综合了PubMed综合检索的结果。共纳入51项研究,包括6项原始研究、26例病例报告、9项回顾性队列研究、9项病例系列研究和2项横断面研究。研究结果表明,超声内镜(EUS)是最准确的诊断工具(准确率为89%),而计算机断层扫描(CT)和钡剂吞片检查提供了补充的结构评估。免疫组织化学染色可区分平滑肌瘤和胃肠道间质瘤(gist),平滑肌瘤表达desmin和平滑肌肌动蛋白(SMA),但缺乏CD34和KIT。对于有症状的肿瘤或超过5厘米的肿瘤,建议进行手术干预。微创技术,包括机器人辅助胸腔镜手术(RATS)和粘膜下隧道内镜切除术(STER),与传统的开放手术相比,提供了更好的结果。与其他入路的1-15%相比,大鼠入路的粘膜损伤率可以忽略不计,而STER可最大限度地减少失血量并加速恢复。虽然短暂性胃食管反流病(GERD)是最常见的并发症,但术后结果通常是良好的。虽然STER和RATS是降低发病率的有效替代方法,但本综述强调了局限性,包括研究设计的可变性、样本量小以及缺乏长期随访数据。需要进一步的前瞻性研究来优化患者选择并建立长期疗效。本综述为食管平滑肌瘤的临床实践和指导未来的研究提供了新的见解。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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