The esophagus functions as a conduit for food after it has been chewed and swallowed. Esophageal submucosal lesions are benign or malignant lesions found under the inner lining of the esophagus (the mucosa). Some of these lesions include esophageal cysts, leiomyomas, and gastrointestinal stromal tumors.
At the Center for Advanced Digestive Care (CADC) at NewYork-Presbyterian/Weill Cornell Medical Center, a team of doctors specializing in esophageal disorders coordinates the care of every patient with submucosal lesions of the esophagus. Our gastroenterologists and interventional endoscopists are able to offer the latest diagnostic approaches and minimally invasive treatments. Patients who require surgery benefit from the experienced thoracic surgeons at NewYork-Presbyterian/Weill Cornell.
Types of Esophageal Submucosal Lesions
Esophageal cysts are benign lesions. Esophageal "duplication" cysts are rare congenital disorders of the foregut, and occur in one in 8,000 live births. Esophageal duplication cysts usually do not cause symptoms in adults. Rarely, they 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 cancerous in nature — a distinction that is sometimes difficult to make.
Symptoms of Esophageal Submucosal Lesions
Esophageal submucosal lesions may not cause any symptoms. They are most often 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 regurgitation of food. Some of these symptoms may ultimately cause weight loss.
Diagnosis of Esophageal Submucosal Lesions
Esophageal submucosal 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" on an imaging test.
In order to better determine which type of lesion a patient has, 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 using fine-needle aspiration. The biopsy is very safe and is accomplished with a small needle inserted through the channel of the endoscope. For more about these procedures, visit the Advanced Interventional Endoscopy page.
Treatment of Esophageal Submucosal Lesions
Once the decision to remove an esophageal submucosal lesion has been made, there are a couple of options to accomplish this goal. In the case of small lesions (about 1cm or less in size) which do not extend too deeply into the esophageal wall, endoscopic mucosal resection (EMR) can be performed. This technique involves the use of an endoscope to remove the lesion.
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. The thoracic surgeons at NYP/Weill Cornell are highly skilled in performing the full range of surgical techniques for the esophagus and use minimally invasive approaches whenever possible, returning patients to their normal activities sooner.