One-step endoscopic removal of a giant double esophageal fibrovascular polyp

Abstract

A 51-year-old woman was evaluated because of mass regurgitation through the mouth (Fig. 1A ), which she held in place by swallowing repeatedly. On upper endoscopy, two long polypoid lesions (Fig. 1B) extended from the cervical oesophagus, below the cricopharyngeal muscle, into the stomach. Multidetector computed tomography showed normal vascularity. After consultation with the surgeon we decided to remove the polyps endoscopically. The procedure was performed in the operating room with the patient under general anaesthesia, using an operative, single channel endoscope. We were able to trap the polyps in the snare and, with gentle twisting movements, we pulled back the endoscope, reached the base, and cut the stalk using blended current (Fig. 1C). No bleeding was observed. The pathologist described a double-elongated mass, with the same base, of 20 cm in length with most areas of myxoid tissue on the cut surfaces. Histologically the polyp was covered by benign squamous epithelium and the core of the lesion consisted of loose myxoid to collagenous fibrous tissue admixed with adipose tissue; focal lymphoplasmacytic infiltrates were also identified. The pathologist finally diagnosed a giant FP without malignancy (Fig. 1D). The patient was discharged 5 days later, with regular oral intake. At follow-up a small residual stalk was seen. Fig. 1(A) mass regurgitation; (B) endoscopic view of the polyps (red arrows); (C) resected specimen (see the common bases); (D) the surface of the polyp is covered by benign squamous epithelium (haematoxylin and eosin). View Large Image Figure Viewer Download Hi-res image