In our patient, barium swallow, endoscopy and CT scan of chest were all diagnostic of leiomyoma. Endoscopic biopsy of the lesion is not recommended for two reasons. First, the fact that these tumors are submucosal means that the yield of the biopsy is nonspecific. Second and more important, following enucleation of the tumor, the site of the biopsy may lead to esophageal fistula. Symptomatic esophageal leiomyomas should be excised provided there are no medical contraindications.
Enucleation is the treatment of choice.
Traditionally, the enucleation is carried out via thoracotomy with all its associated morbidity. The procedure is not without complications and surgical pitfalls should be anticipated and avoided. Jesic et al. successfully enucleated a leiomyoma of the lower third of the esophagus through a transhiatal approach. Some authors have advocated video thoracoscopy as the technique of choice for the enucleation of esophageal leiomyomas. 2,3 Asymptomatic patients can be treated conservatively without surgical intervention.