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Challenging Use of Digestive Endoscopic Tunnel Technique to Treat Schwannoma Originating in the Trachea

Chai, Ningli MD1; Wang, Shasha MM1; Xiang, Jingyuan MM1; Zhai, Yaqi MM1; Li, Longsong MM1; Xu, Shanshan MM1; Linghu, Enqiang MD1

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The American Journal of Gastroenterology: May 2020 - Volume 115 - Issue 5 - p 650
doi: 10.14309/ajg.0000000000000629

A 51-year-old man underwent esophageal submucosal tunneling endoscopic resection in our department to resect a 1.5-cm submucosal mass located 25 cm from the incisors (a). Endoscopic ultrasonography showed that the mass was regular, had low-density, and had a clear boundary (b). When the mass was being separated layerwise using a hybrid knife, endoscopy imaging showed that it was beyond the esophagus and attached to the trachea (c). To remove the mass completely, we continued separating the mediastinum tissue and the trachea as carefully as possible; finally, a defect of 1.5 cm diameter was caused above the carina of the trachea (d). We removed the tumor using a snare and applied electrocoagulation hemostasis and then, clips and fibrin glue were used to close the entry of the tunnel tightly (e). After the operation, bronchoscopy showed that the defect was sealed by the esophageal mucosa, and because of the negative intrathoracic pressure, the protrudent mucosa was sort of fluttering accompanied with respiratories (f). The patient was given conservative treatment and placed in the right lateral position for 3 weeks with a nutrition tube. Bronchoscopy follow-up at 1 week showed that the tracheal membrane was growing well and the mucosa of the esophagus was smooth without perforation. Computed tomography and hemogram showed no infection and pneumothorax in the following 4 weeks. Three months after the operation, there were no significant differences between the defect and the normal tracheal membrane (g). An R0 resection was achieved, and the specimen was pathologically confirmed to be a schwannoma originating in the trachea (h). To our knowledge, this is the first reported case of resecting a tumor in the membranous wall of the trachea with digestive endoscopic tunnel technique. However, further follow-up is required to determine the long-term efficacy (see Video, Supplementary Digital Content 1, (Informed consent was obtained from the patient to publish these images.)

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