• Esophageal Submucosal Lesions
• Esophageal Cancer
• Barrett's Esophagus
• Celiac Disease
• Gastric Malignancies
• GERD
• Non-Cancerous Stomach Conditions

What are esophageal submucosal lesions?

TThe esophagus functions as a conduit for food once it is chewed and swallowed. Esophageal submucosal lesions can be benign or malignant lesions found under the esophageal mucosa (the inner coat of the esophagus). Some of these lesions include esophageal cysts, leiomyomas, and gastrointestinal stromal tumors.

Esophageal cysts are benign. Esophageal "duplication" cysts are a rare congenital disorder of the foregut, and occur in one in 8,000 live births. Esophageal duplication cysts are mostly asymptomatic in adults, and rarely these cysts can become cancerous.

Esophageal leiomyomas are rare lesions that make up less than 1 percent of esophageal tumors, and are the most common benign tumors of the esophagus. Esophageal gastrointestinal stromal tumors (GIST) are also rare. GISTs most commonly occur in the stomach or small intestine, but a smaller number can develop in the esophagus. These tumors can be benign or malignant in nature, but such a distinction is sometimes difficult to make.

What symptoms are associated with this condition?

Esophageal lesions can be asymptomatic and are commonly discovered during routine upper endoscopic examination of the esophagus for another problem, such as reflux disease (heartburn), abdominal pain, or unexplained weight loss. In some cases, these lesions can result in difficulty swallowing (dysphagia), food getting stuck in the esophagus, chest pain, or the regurgitation of food. Some of these symptoms can ultimately result in weight loss.

How are they diagnosed?

These lesions are usually diagnosed incidentally by imaging methods such as computed tomography (CT), magnetic resonance imaging (MRI), or standard upper endoscopy. They appear as a bulge ("submucosal mass lesion"), with normal overlying esophageal mucosa.

In order to better determine which type of lesion you have, our team of advanced endoscopists offers a technology known as endoscopic ultrasound (EUS). This technology makes it possible to visualize the lesion in fine detail within the esophagus by using an ultrasound device at the tip of an endoscope. It provides real-time, close-up images of the lesion. EUS also makes it possible to take samples (biopsies) of the lesion with fine-needle aspiration (FNA). The sampling is accomplished with a small needle inserted through the channel of the endoscope, and is a safe method.

For more about these procedures, visit the Advanced Interventional Endoscopy page.

What treatments are available?

Once the decision to remove an esophageal lesion has been made, there are a couple of options to accomplish this goal. In the case of small lesions, which are not too deep in the esophageal wall, endoscopic mucosal resection (EMR) can be performed. This technique involves the use of an endoscope to remove the lesion. Esophageal EMR is best performed in the case of small lesions (about 1cm or less in size).

In the case of large lesions or those lying deep within the esophagus, your doctor may have you see a thoracic surgeon to consider minimally invasive surgery to remove the lesion. In some instances, removal of a portion of the esophagus (esophagectomy) must be performed. Our thoracic surgeons are highly skilled in performing the full range of surgical techniques.

How can I make an appointment to see an advanced endoscopist?

Our specialists are experienced in diagnosing and treating esophageal disorders. An interdisciplinary team of gastrointestinal specialists in endoscopy, radiology, and surgery work together as a team to provide each patient with coordinated, advanced, and individualized care. Please contact our Advanced Interventional Endoscopy team to discuss your case.