Slicing Through the Options: A Systematic Review of Esophageal Leiomyoma Management
Abstract
Esophageal leiomyomas are rare, benign tumors that can remain asymptomatic or cause dysphagia and chest discomfort when they grow large. Despite advancements in diagnostic and therapeutic strategies, optimal management remains debated. This systematic review evaluates current diagnostic modalities and treatment approaches, synthesizing findings from a comprehensive PubMed search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 51 studies were included, comprising six original studies, 26 case reports, nine retrospective cohort studies, nine case series, and two cross-sectional studies. Findings indicate that endoscopic ultrasonography (EUS) is the most accurate diagnostic tool (89% accuracy), while computed tomography (CT) and barium swallow studies provide complementary structural assessments. Immunohistochemical staining differentiates leiomyomas from gastrointestinal stromal tumors (GISTs), with leiomyomas expressing desmin and smooth muscle actin (SMA) but lacking CD34 and KIT. Surgical intervention is recommended for symptomatic tumors or those exceeding 5 cm. Minimally invasive techniques, including robotic-assisted thoracoscopic surgery (RATS) and submucosal tunneling endoscopic resection (STER), offer superior outcomes compared to traditional open surgery. RATS demonstrates a negligible mucosal injury rate versus 1-15% for other approaches, while STER minimizes blood loss and accelerates recovery.…
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