Multiple Esophageal Leiomyoma Presenting with Clinical Dysphagia from Mechanical Obstruction and Motility Disorder

Esophageal leiomyoma is uncommon. However, this tumor is the most common subepithelial tumor affecting the esophagus, comprising approximately two-thirds of benign esophageal tumors. Leiomyomas of the esophagus rarely cause symptoms when they are single and <5 cm. The mainstay of treatment is esophagectomy for symptomatic patients. A 68-year-old male patient presented with progressive dysphagia for 4 months. The degree of dysphagia and chest discomfort was more severe on solid rather than liquid diet. The CT scan of the chest showed multiple well-defined, submucosal nodules, up to 1.9 cm in diameter located at the middle esophagus. The barium swallow study illustrated multiple, well-defined, smooth, semilunar filling defects along the mid to distal esophagus. Meanwhile, esophagogastroduodenoscopy revealed 8 smooth subepithelial masses. Moreover, the radial EUS showed multiple hypoechoic masses arising from the 4th layer, with some of the tumors connected to others as a horseshoe-like shape causing narrowed lumen. Last, high-resolution esophageal manometry revealed ineffective esophageal motility. We report a rare case of numerous esophageal leiomyomas which caused dysphagia as a result of both mechanical obstruction and hypomotility disorder. The histopathology confirmed the diagnosis of esophageal leiomyoma. Symptoms improved significantly after lifestyle modifications and adherence to dietary advice on the part of the patient.

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Artifact in Barium Swallow Study in an Individual with Dysphagia Aortica

Journal of the American Geriatrics Society ◽

10.1111/jgs.13994 ◽

2016 ◽

Vol 64 (3) ◽

pp. 693-693

Author(s):

Manfred Gogol

Keyword(s):

Barium Swallow ◽

Swallow Study

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Giant Fibrolipoma of the Esophagus

Case Reports in Otolaryngology ◽

10.1155/2012/406167 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Ryan L. Kau ◽

Alpen B. Patel ◽

Michael L. Hinni

Keyword(s):

Diagnostic Tool ◽

Barium Swallow ◽

Benign Tumors ◽

Esophageal Obstruction ◽

Transthoracic Approach ◽

Esophageal Tumors ◽

Microsurgical Approach ◽

Pedunculated Polyp ◽

Tool Treatment

Benign tumors of the esophagus are uncommon, representing <0.5% of esophageal tumors. Fibrolipomas are a subset of benign fibrovascular tumors, which present with dysphagia, odynophagia, and substernal fullness. These intraluminal tumors can become elongated and molded into a long pedunculated polyp by constant peristaltic movements. They can cause esophageal obstruction if large and long enough and can cause asphyxiation if they become lodged into the glottis. A barium swallow is the main diagnostic tool; treatment is surgical via a transoral, transcervical, or transthoracic approach. We report the excision of a large esophageal fibrolipoma through a transoral laser microsurgical approach.

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690 MINIMALLY INVASIVE APPROACH FOR ESOPHAGEAL LEIOMYOMA

Diseases of the Esophagus ◽

10.1093/dote/doab052.690 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Norberto Daniel Velasco Hernandez ◽

Héctor Rául Horiuchi ◽

Lucas Abal ◽

Matías Sabatini ◽

Agustina Redondo ◽

...

Keyword(s):

Minimally Invasive ◽

Prone Position ◽

Surgical Approaches ◽

Barium Swallow ◽

Esophageal Leiomyoma ◽

Old Patients ◽

Invasive Approach ◽

Endoscopic Stent ◽

Common Benign Tumor ◽

History Of

Abstract Esophageal leiomyoma is the most common benign tumor of the esophagus. Although enucleation via thoracotomy has been considered standard treatment, minimally invasive surgery is increasingly used for the treatment of this disease. The authors report the clinical outcomes of three procedures for enucleation. Methods From November 2011 to December 2020, 3 females (52, 58, and 67 years old) patients were treated for leiomyoma of the middle third of the esophagus. A history of dysphagia and chest pain was present. Upper gastrointestinal endoscopic, computerized tomography, and endoscopic ultrasound were performed, in only one case barium swallow was used. Results The surgical approaches included right thoracoscopy in prone position, enucleation, and small thoracotomy for removing the specimen. There were no major morbidities, including deaths. One patient presented a leak, which was resolved with an endoscopic stent. Conclusion Minimally invasive enucleation of esophageal leiomyoma can be performed effectively and safely. Right thoracoscopic in prone position for the removal of esophageal leiomyomas may be recommended as the treatment of choice in centers experienced with esophageal surgery.

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Benign Esophageal Tumors

Gastrointestinal Imaging ◽

10.1093/med/9780199759422.003.0007 ◽

2015 ◽

pp. 33-35

Author(s):

Marc S. Levine

Keyword(s):

Esophageal Tumors ◽

Benign Esophageal Tumors

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Leiomyoma of the Esophagus

Tumori Journal ◽

10.1177/030089168607200509 ◽

1986 ◽

Vol 72 (5) ◽

pp. 503-506 ◽

Cited By ~ 4

Author(s):

Ferdinando Preda ◽

Marco Alloisio ◽

Cosimo Lequaglie ◽

Mauro Ongari ◽

Gianluigi Ravasi

Keyword(s):

Esophageal Cancer ◽

Differential Diagnosis ◽

Preoperative Diagnosis ◽

Long Term Results ◽

Barium Swallow ◽

Thoracic Esophagus ◽

Esophageal Leiomyoma ◽

Correct Preoperative Diagnosis ◽

Clinical Records

A review of the clinical records from 1947 to 1984 of the Istituto Nazionale Tumori of Milan provided 20 cases (14 males and 6 females) of esophageal leiomyoma. Eighteen of the tumors were in the thoracic esophagus and 2 were at the cardiac level. The most frequent symptoms were dysphagia, slight epigastralgia and odynophagia. Differential diagnosis should be made with mediastinic neoplasms and esophageal cancer. Barium swallow and esophagoscopy are the most sensitive procedures for a correct preoperative diagnosis. Surgery is mandatory because of the tendency to a continuous endoluminal growth (in 97% of the cases) and a possible malignant transformation. However, surgery is conservative: extramucosal enucleation of the leiomyoma is the procedure of choice. The long-term results are excellent, and morbidity is acceptable.

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P173 HIGH-RESOLUTION MANOMETRIC FINDINGS AFTER MAGNETIC SPHINCTER AUGMENTATION

Diseases of the Esophagus ◽

10.1093/dote/doz092.173 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

Carlo Galdino Riva ◽

Stefano Siboni ◽

Veronica Lazzari ◽

Marco Sozzi ◽

Emanuele Asti ◽

...

Keyword(s):

High Resolution ◽

Esophageal Motility ◽

Symptom Relief ◽

Rank Test ◽

Barium Swallow ◽

Upper Gastrointestinal Endoscopy ◽

Magnetic Sphincter Augmentation ◽

Hrql Score ◽

High Resolution Manometry ◽

Ineffective Esophageal Motility

Abstract Aim The aim of this study was to evaluate esophageal motility before and after Magnetic Sphincter Augmentation (MSA) for medically refractory Gastro-Esophageal Reflux Disease (GERD). Background and Methods MSA (LINX® Reflux Management System) is intended for patients with chronic GERD with incomplete symptom relief from proton-pump inhibitors (PPI) and abnormal acid exposure. A prospectively collected database of patients who underwent MSA between 2007 and 2019 was queried. All patients who completed pre- and post-operative high-resolution manometry (HRM) were included in the study. Additional investigations included Health-Related Quality of Life (GERD-HRQL) questionnaire, Functional Outcome Swallowing Scale (FOSS), upper gastrointestinal endoscopy, barium swallow, and 24-96 hours pH-study. Data were analyzed using Wilcoxon signed rank test and McNemar test. Results Forty-five patients met the inclusion criteria. The median follow-up was 10 months (IQR 6). Compared to baseline, there was a statistically significant reduction in PPI use (p=0.000), rate of heartburn (p=0.000), regurgitation (p=0.008), and extra-esophageal symptoms (p=0.000). Only three (6.7%) patients required dietary changes. The GERD-HRQL score significantly improved (p=0.000). There was a significant increase in the Lower Esophageal Sphincter (LES) competency, including LES length (p=0.004) and Esophago-gastric Contractile Integral ((EGJ-CI) (p=0.000). A significant increase in integrated relaxation pressure (IRP) (p=0.000), mean Distal Contractile Integral (DCI) (p=0.008) and intrabolus pressure (p=0.000) was also found. Thirteen (28.9%) patients presented pre-operative Ineffective Esophageal Motility (IEM) and five of them resolved postoperatively. Two patients (4.4%) developed IEM after surgery: both had IRP and DCI values within normal limits, and one of them complained of dysphagia. However, the GERD-HRQL score recovered in both patients. Conclusion MSA was clinically effective in relieving both typical and atypical GERD symptoms. LES competency increased after MSA. EGJ outflow obstruction was uncommon and not associated with symptoms. Finally, ineffective esophageal motility may reverse to normal after MSA.

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Retained Esophageal Contrast on Modified Barium Swallow Study Predicts Abnormal High Resolution Esophageal Manometry

Gastroenterology ◽

10.1016/s0016-5085(17)32438-1 ◽

2017 ◽

Vol 152 (5) ◽

pp. S697

Author(s):

David Lin ◽

Jeremy Wang ◽

Andrew A. Erman ◽

Dinesh Chhetri ◽

Conklin Jeffrey

Keyword(s):

High Resolution ◽

Esophageal Manometry ◽

Barium Swallow ◽

Modified Barium Swallow ◽

Swallow Study ◽

Modified Barium Swallow Study

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Identification of Swallowing Tasks From a Modified Barium Swallow Study That Optimize the Detection of Physiological Impairment

Journal of Speech Language and Hearing Research ◽

10.1044/2017_jslhr-s-16-0117 ◽

2017 ◽

Vol 60 (7) ◽

pp. 1855-1863 ◽

Cited By ~ 15

Author(s):

R. Jordan Hazelwood ◽

Kent E. Armeson ◽

Elizabeth G. Hill ◽

Heather Shaw Bonilha ◽

Bonnie Martin-Harris

Keyword(s):

Generalized Estimating Equations ◽

High Probability ◽

Secondary Data ◽

Barium Swallow ◽

Oral Clearance ◽

Airway Protection ◽

Modified Barium Swallow ◽

Severe Impairment ◽

Swallow Study ◽

Modified Barium Swallow Study

Purpose The purpose of this study was to identify which swallowing task(s) yielded the worst performance during a standardized modified barium swallow study (MBSS) in order to optimize the detection of swallowing impairment. Method This secondary data analysis of adult MBSSs estimated the probability of each swallowing task yielding the derived Modified Barium Swallow Impairment Profile (MBSImP™©; Martin-Harris et al., 2008) Overall Impression (OI; worst) scores using generalized estimating equations. The range of probabilities across swallowing tasks was calculated to discern which swallowing task(s) yielded the worst performance. Results Large-volume, thin-liquid swallowing tasks had the highest probabilities of yielding the OI scores for oral containment and airway protection. The cookie swallowing task was most likely to yield OI scores for oral clearance. Several swallowing tasks had nearly equal probabilities (≤ .20) of yielding the OI score. Conclusions The MBSS must represent impairment while requiring boluses that challenge the swallowing system. No single swallowing task had a sufficiently high probability to yield the identification of the worst score for each physiological component. Omission of swallowing tasks will likely fail to capture the most severe impairment for physiological components critical for safe and efficient swallowing. Results provide further support for standardized, well-tested protocols during MBSS.

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Pyriform Sinus Fistula: An Unusual Cause of Recurrent Retropharyngeal Abscess and Cellulitis

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948609500411 ◽

1986 ◽

Vol 95 (4) ◽

pp. 377-382 ◽

Cited By ~ 38

Author(s):

Howard L. DeLozier ◽

Robert A. Sofferman

Keyword(s):

Thyroid Gland ◽

Surgical Approach ◽

Pyriform Sinus ◽

Retropharyngeal Abscess ◽

Barium Swallow ◽

Suppurative Thyroiditis ◽

Common Cause ◽

Surgical Exploration ◽

Swallow Study ◽

Congenital Fistula

Recurrent retropharyngeal cellulitis and recurrent suppurative thyroiditis are rare entities that share a common cause. A congenital fistula from the pyriform sinus apex to the thyroid gland has been identified in approximately 23 cases of suppurative thyroiditis and now has been implicated in a case of retropharyngeal abscess and repeated episodes of cellulitis. Virtually all reported cases have been on the left side, and the fistula is usually identified with a barium swallow study. When the esophagogram fails to demonstrate a fistula, a careful endoscopic search in the area of the left pyriform sinus should be actively pursued. An external surgical approach, which includes resection of the entire tract and involved area of the left thyroid, has been curative in all reported cases subjected to definitive surgical exploration.

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