Move knife tip on the thoracic aorta: a high-risk submucosal tunneling endoscopic resection (STER) procedure for a puzzle submucosal mass in esophagus (with video)

A 43-year-old men was found an esophageal submucosal mass at 26 cm from the incisors; and preoperative EUS suggested a leiomyoma in MP layer. STER^{1, 2}, deriving from POEM^{3, 4}, was performed, and an inverse T incision⁵ was carried out firstly. Subsequently, a submucosal tunnel was established extending to the distal esophagus; and a mass, covered with MP tissue, was discovered (Figure 1); particularly, the mass was going up and down rhythmically, and had soft touch; given the possibility of aorta compression or cyst, ECDUS was conducted and uncovered a homogeneous hypoechoic lesion, just against thoracic aorta (Figure 2). Thus, we speculated the lesion was a cyst, given the soft touch of the mass.

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