Modified endoscopic submucosal tunnel dissection for large esophageal submucosal gland duct adenoma: A case report

Figure 1 Endoscopic findings. One 35-mm submucosal tumor was located in the lower thoracic esophagus, with a central depression with a reddish appearance.

Figure 2 Endoscopic ultrasound findings. A: A well-defined heterogeneous, hypoechoic lesion with scattered small anechoic areas in the third layer; B: No vascular flow within the lesion; C: A hard mass revealed by elastography.

Figure 3 Endoscopic ultrasound - fine-needle aspiration findings. A: Cytological analysis; B: Histological analysis.

Figure 4 Schema of modified endoscopic submucosal tunnel dissection. A: Endoscopic submucosal tunnel dissection located in the submucosal layer; B: Oral end of the involved mucosa cut transversely; C: Submucosal tunnel created from the proximal end to the distal end; D: One lateral mucosa resected; E: The other lateral mucosa resected; F: Anal end of the involved mucosa resected.

Figure 5 Post-Endoscopic submucosal tunnel dissection pathology. A: A cystic pattern with distinct 2-cell layers; B: Eosinophilic inner luminal cells.