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New Delhi, May 14, 2023:
Recently Sir Ganga Ram Hospital received a 30 years old male patient presenting with difficulty in swallowing. On investigations doctors were surprised to see a large tumor of the size of 6.5 cms, bulging into the food pipe.
According to Prof. Anil Arora, Chairman, Institute of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, “We recently removed a large submucosal tumor (6.5 cm in size) from the foodpipe (esophageal leiomyoma-A tumor arising from the muscular layer of esophagus and protruding into the lumen causing dysphagia) (Figure 1) in a 30 year old male patient presenting with difficulty in swallowing. To the best of our knowledge, this was one of the largest tumor, removed endoscopically, in India (Figure 2). This procedure is known as submucosal tunneling and endoscopic resection (STER). These types of large tumors are traditionally removed by surgery which has far more morbidity, is more expansive and is associated with longer hospital stay.”
According to Dr. Shivam Khare, Consultant, Department of Gastroenterology, Sir Ganga Ram Hospital, “While elaborating the steps of procedure said that In this STER procedure, Firstly we injected saline at the base of tumor that helped us lift the tumor, and create a tunnel all around it by dissection of fibrous tissue, around the tumor, and in separating it from all layers of food pipe. Once tumor got separated, we were able to scoop the tumor in lumen (cavity) of esophagus from the submucosal tunnel behind the esophageal wall into the esophageal lumen. Subsequently the tumor was successfully retrieved from the mouth and the patient was discharged after two days with gradual resumption of the normal diet (Figure 3).”
Prof. Anil Arora said, “Endoscopic removal of large tumor is a challenging task. Generally regular oval shaped smooth esophageal tumor up to 3 cm size can be removed endoscopically by expert endoscopist but in our case tumor was more than 6 cm in size with lobulated irregular pear shaped configuration. Irregular shape makes it difficult to separate the tumor from all layers of food pipe.”
Dr. Shivam Khare added, “Second challenge was the sheer size of the tumor as it created hurdles not only in mobilizing it out of submucosal tunnel into esophageal lumen but also in getting it out from esophagus via throat through mouth. Fortunately a wide range of accessories and endoscopic instruments helped us in successful completion of the procedure without any complications.”
Prof. Anil Arora said, “With a state of art facility & availability of new advanced endoscopic technologies, we routinely perform many such endoscopic procedures like peroral endoscopic myotomy (POEM) for achalasia cardia, endoscopic mucosal resection or submucosal dissection (EMR/ESD) for superficial early gastrointestinal cancers ushering in a new era of endoscopic diagnosis and treatment of benign and malignant lesions of the gastrointestinal tract.”
Recent developments in the field of Therapeutic endoscopy have opened the doors of a new world of minimal invasive, incision less, nonsurgical treatment for various tumors lying within the lumen and the wall of the Gastrointestinal tract. With the availability of high tech endoscopy equipment, providing high resolution real time visualization of inner cavities and walls of esophagus (food pipe), stomach and intestine, now, it is, not only possible, to diagnose cancer in the early stage of their development, but also to carry out a possible curative treatment by deft endoscopic maneuvers, using advance endoscopic machines and instruments.
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