EUS for choosing best endoscopic treatment of mesenchymal tumors of upper gastrointestinal tract

Figure 1 An esophageal leiomyoma treated by snare electrosection. A: An elevated lesion in the lower esophagus; B: A homogeneous, hypoechoic mass (1.0 × 0.7 cm²) with a regular border originated from muscularis mucosa, which was diagnosed as a leiomyoma by endoscopic ultrasonography; C: The tumor was snared at the base, and then it was resected by snare electrosection; D: Postoperative wounds.

Figure 2 A gastric stromal tumor treated by endoscopic mucosal resection. A: An elevated lesion in the cardia; B: A homogeneous, hypoechoic mass (1.4 × 0.8 cm²) with a regular border originating from submucosa, which was diagnosed as a stromal tumor by endoscopic ultrasonography; C: Epinephrine (0.001%) was injected into the submucosa to lift the lesion; D: Postoperative wounds.

Figure 3 A gastric stromal tumor treated by endoloop. A: An elevated lesion in gastric fundus; B: A homogeneous, hypoechoic mass (2.0 × 1.5 cm²) with a regular border originating from muscularis propria, which was diagnosed as a stromal tumor by endoscopic ultrasonography; C: Endoscopic ligation with an endoloop; D: Endoscopic view of an ulcer scar without tumor recurrence at the ligation site 2 mo later.

Figure 4 A gastric stromal tumor treated by endoscopic submucosal dissection. A: An elevated lesion in the gastric antrum; B: A homogeneous, hypoechoic mass (2.0 × 1.2 cm²) with a regular border originating from muscularis propria, which was diagnosed as a stromal tumor by endoscopic ultrasonography; C: The surrounding area of the lesion was marked with argon plasma coagulation. After normal saline solution with 0.002% indigo carmine and 0.001% epinephrine was injected into the submucosal layer to lift the lesion, an initial incision was made outside the marking dots with hook-knife. Submucosal dissection under the lesion was performed with an IT knife; D: The tumor was dissected and the postoperative wounds were closed using hemoclip.