Endoscopic submucosal dissection for primary malignant esophageal melanoma (with video)

摘要

A 70-year-old man with diabetes mellitus and a 5-month history of chronic kidney disease on peritoneal dialysis presented with 1 month of severe dysphagia. EGD revealed a large, polypoid, pedunculated, type "O-Ip" esophageal tumor, with black pigmented and red-colored areas. Easy movement of the tumor by retraction with the endoscopic forceps showed no apparent fixation to the muscularis propria (A). Biopsy specimens showed positivity for melanin staining. No primary cutaneous or ocular lesions were detected. A primary malignant esophageal melanoma was diagnosed after excluding other primary sites by thoracic and abdominal CT, colonoscopy, and bone scanning. The patient was deemed a poor candidate for surgery and because of significant comorbidities underwent an uncomplicated ESD (B). CO2 insufflation was used during the Ill-minute procedure to minimize the possibility of pneu-momediastinum.