SESAP Critique
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**I****tem** **228**

Although not common, leiomyoma is the most frequently occurring benign tumor of the esophagus. Many lesions are small and asymptomatic, but persistent slow growth with the eventual development of symptoms is predictable, and excision of identifiable lesions is indicated.

Leiomyomas do not involve the esophageal mucosa and rarely adhere to contiguous structures. Complete removal is necessary to prevent continued growth and recurrence of symptoms. The preferred excisional technique is esophagomyotomy and enucleation. Endoscopic resection avoids the need for thoracotomy but involves disruption of the esophageal mucosa and may result in a predisposition to subsequent stricture formation. Completeness of resection may result in a predisposition to subsequent stricture formation. Completeness of resection may also be less reliable with this approach. More extensive extirpative techniques such as segmental or complete esophagectomy are unnecessary; lesser techniques such as esophageal dilatation are ineffective.

## References

1.  228/1.1.  Zuidema GD
    
    Postlethwaite RW, Lowe JE: Benign tumors and cysts of the esophagus, in Zuidema GD (ed): Shackelford’s Surgery of the Alimentary Tract, ed 3. Philadelphia, WB Saunders Co, 1991, pp 337–341
    
    

2.  228/2.1.  Nora PF
    
    Scanlon EF: The esophagus, in Nora PF (ed): Operative Surgery. Philadelphia, Lea & Febiger, 1974, pp 293, 296