Endoscopic mucosal resection of a mid-esophageal carcinoid with EUS guidance

history of panhypopituitarism necessitating hydrocortisone and levothyroxine supplementation underwent upper endoscopy because of heartburn, and an esophageal submucosal lesionwas detected. Surface biopsies were normal. Upper endoscopy was repeated at our institution and a 1-cm red-hued submucosal polypoid lesion was noted at 28 cm from the incisors (●" Fig. 1). Endoscopic ultrasonography (EUS) was performed with an Olympus 3R 20-MHz ultrasound probe (Olympus, Melville, New York, USA) (●" Fig. 2). The lesion was demarcated in the deep mucosa and submucosa as a homogenous hypoechoic entity without definite muscularis propria invasion. Endoscopic mucosal resection (EMR) was performed utilizing a small submucosal cushion of saline injected by a sclerotherapy needle and a 13-mm snare. The lesion was removed via snare electrocautery. Pathological analysis demonstrated a submucosal neoplasm composed of tumor cells arranged in sheets, glands, and trabeculae without mitoses (●" Fig. 3). Immunohistochemical studies demonstrated positivity for synaptophysin and chromogranin, suggestive of an esophageal carcinoid (●" Figs. 4,●" 5). Twoweeks after the procedure the patient was contacted and reported no complaints. Endoscopy 2 months later demonstrated mucosal scarring without residual lesion and surface and “tunnel” biopsies did not reveal any abnormalities. CT imaging of Endoscopic mucosal resection of a mid-esophageal carcinoid with EUS guidance