Which of the following statements about the diagnosis and treatment of esophageal leiomyomas is/are correct?

D. Endoscopic ultrasonography is a reliable means of following leiomyomas conservatively.

DISCUSSION: Most esophageal leiomyomas are asymptomatic when discovered incidentally on a barium esophagogram or upper gastrointestinal tract series. When suspected on the basis of its radiographic appearance, biopsy of the mass should not be performed at the time of esophagoscopy, so that subsequent extramucosal resection will not be complicated by scarring at the biopsy site. The preferred surgical approach is submucosal enucleation of the mass, not full-thickness excision. Leiomyomas have a characteristic hypoechogenic homogeneous appearance on esophageal ultrasonography that allows a noninvasive diagnosis and means of surveillance. Submucosal enucleation of leiomyomas, without wide local excision, provides excellent long-term results with virtually no local recurrence rate.