Successful ablation of a large fibrovascular polyp of the esophagus by endoscopic Nd:YAG laser therapy

Abstract

Although its occurrence is rare, fibrovascular polyp is the most common intraluminal benign tumor of the esophagus. This slow growing, pedunculated tumor produces late symptoms. The tumor can become very large, >10 cm in length. Symptoms are related to esophageal obstruction and tracheal compression. Hematemesis and fatal laryngeal obstruction by a regurgitated polyp have been reported.4 The vascularity of these tumors, their large size, and the presence of a stalk attached to the high cervical esophagus make surgical resection the preferable mode of resection. Patel et a1. reported surgical excision of a fibrovascular esophageal polyp, with high cervical attachment that measured 17 cm. This surgical excision was accomplished through an oblique incision along the anterior border of the left sternocleidomastoid muscle. The vessels in the pedicle can be isolated from the base and individually ligated and divided, ensuring complete hemostasis. When the polyp is more distal, the surgical excision must be accomplished through a thoracotomy incision. For patients with contraindications to thoracotomy, we propose a nonoperative alternative: endoscopic neodymium:yttrium-aluminum-garnet (Nd:YAG) laser ablation.