EUS-FNABにて術前診断した食道GISTに対し胸腔鏡下核出術を施行した1例

An esophageal GIST diagnosed by endoscopic ultrasound-guided fine-needle aspiration biopsy and treated by thoracoscopic enucleation

◆要旨：PET検診にて指摘され術前低リスク食道GISTと診断しえた症例に対して胸腔鏡下核出術を行ったので報告する．手術は左半腹臥位，片肺分離換気，気胸併用下に3ポートで胸腔鏡下に行った．術中内視鏡にて腫瘍直下の粘膜下層にインジゴカルミン加ヒアルロン酸を局注したのちに，胸腔鏡下に食道外膜・筋層を切開剝離して腫瘍を核出した．病理検査では腫瘍径16×14mmの超低リスクGISTであった．術後10病日に軽快退院しており，術後1年経過しているが無再発経過中である．低リスク食道GISTに対しては胸腔鏡下核出術は有用な方法であると考えられ，術式決定のためにも術前EUS-FNABは可能な限り行うべきである．

We describe diagnosis and treatment of a low-risk esophageal gastrointestinal stromal tumor（GIST） that was identified during a positron emission tomography health screening and remedied by means of thoracoscopic enucleation. The patient was placed in the left semiprone position, and one-lung ventilation and artificial pneumothorax were established. Under endoscopic guidance, hyaluronic acid with indigo carmine was injected into the submucosa immediately beneath the tumor. The tumor was then approached thoracoscopically via three ports, the esophageal adventitia and muscular layer were incised and dissected, and the tumor was enucleated. Pathological examination revealed a very low grade 16×14-mm GIST. The postoperative course was uneventful, and the patient was discharged on postoperative day 10. One year has passed, and there have been no signs of recurrence. We believe that thoracoscopic enucleation is a useful treatment for low-risk esophageal GIST. In addition, preoperative endoscopic ultrasound-guided fine-needle aspiration biopsy should be performed whenever possible for the purpose of deciding on a suitable surgical technique.