Esophageal Polyp Research Articles

S3258 A Rare Case of Eosinophilic Esophagitis Presenting as Multiple Esophageal Polyps

S3258 A Rare Case of Eosinophilic Esophagitis Presenting as Multiple Esophageal Polyps

Exploring the Incidence and Associated Risk Factors of Barrett's Esophagus in African Americans: A Retrospective Study.

The prevalence of Barrett's esophagus (BE) in African Americans (AA) is uncertain. However, several potential risk factors, includes family history, male sex, ethnicity, chronic heartburn and acid reflux, age over 60, current or past smoking, and obesity are associated with BE. The aim of this study is to determine the incidence of BE in AA patients who underwent Esophageal Gastro Endoscopy (EGD). Medical and demographic data of 1,253 AA patients with various symptoms, including BE, Esophageal adenocarcinoma (EAC), esophageal squamous adenocarcinoma (SCC), hiatal hernia, H. pylori infection, Gastro-Esophageal Reflux Disease (GERD), Gastritis, and esophagitis, were collected from January 2004 to December 2014 at Howard University Hospital. Among the 1,253 patients, the median age was 61 and 49% were male out of the total. The frequencies of EAC (p= 0.05), and SCC (p= 0.002) were significantly high in males, along with SCC frequency significantly increased with older age (p<0.001). Furthermore, esophageal polyps with hiatal hernia (p=0.008) and H. pylori (p=<0.001) were found to be associated with esophagitis, and its presence may contribute to the development of BE. The findings highlighted the high prevalence of GERD symptoms and pathologic gastritis along with EAC was less common than SCC and both types of esophageal cancer were associated with male gender and older age whereas, H. pylori infection was identified as a risk factor for pathologic gastritis in AA. Overall data emphasize the need for extensive research, increased awareness, diagnosis, and management of GERD, gastritis, and related conditions to uncover the underlying mechanisms and factors contributing to these conditions in the AA population.

Evaluation of non-gastric upper gastrointestinal system polyps: an epidemiological assessment

Non-gastric upper gastrointestinal system polyps are detected rarely and mostly incidentally during upper gastrointestinal endoscopy. While the majority of lesions are asymptomatic and benign, some lesions have the potential to become malignant, and may be associated with other malignancies. Between May 2010 and June 2022, a total of 127,493 patients who underwent upper gastrointestinal endoscopy were retrospectively screened. Among these patients, those who had polyps in the esophagus and duodenum and biopsied were included in the study. A total of 248 patients with non-gastric polyps were included in this study. The esophageal polyp detection rate was 80.00/100,000, while the duodenal polyp detection rate was 114.52/100,000. In 102 patients (41.1%) with esophageal polyps, the mean age was 50.6 ± 15.1, and 44.1% (n = 45) were male. The most common type of polyps was squamous papilloma (n = 61, 59.8%), followed by inflammatory papilloma (n = 18, 17.6%). In 146 patients (58.9%) with duodenal polyps, the mean age of patients was 58.3 ± 16.5, and 69.8% (n = 102) were male. Brunner's gland hyperplasia, inflammatory polyp, ectopic gastric mucosa, and adenomatous polyp were reported to be the most prevalent types of polyps in the duodenum overall (28.1%, 27.4%, 14.4%, and 13.7%, respectively). It is crucial to identify rare non-gastric polyps and create an effective follow-up and treatment plan in the era of frequently performed upper gastrointestinal endoscopies. The epidemiological assessment of non-gastric polyps, as well as a follow-up and treatment strategy, are presented in this study.

Abdominal Epilepsy, A Diagnosis to Consider in Children with Recurrent Vomiting: A Case Report

gastrointestinal complaints and central nervous system involvement, mainly confusion, fatigue, headache, dizziness, syncope, and lethargy resulting during the abdominal seizure activity. Chronic vomitting or other gastrointestinal symptoms often lead to fluid and nutritional deficiencies which resulted in malnutrition. To date, there was no study has been reported on abdominal epilepsy in Indonesia. Case Presentation: We presented a case of two-year-old girl with chief complaint of recurrent profuse vomiting every month for the past year. Patient complained of headaches and abdominal pain and tended to sleep all day during relapse. Physical examination showed sunken eyes and decreased skin turgor. EEG showed abnormal results, diffuse irritative, epileptiform with normal basic rhythm. Esophageal polyps were also found on endoscopy. Patient was given anti-epileptic drugs and histamine H2 receptor antagonists and responded well to those therapies. Conclusion: Abdominal epilepsy is a rare case which may resulted in vomiting and abdominal pain in children. EEG examination is an important test for diagnosing abdominal epilepsy. Treatment with anti-epileptic drugs is known to respond well in this case.

ESOPHAGEAL SQUAMOUS CELL PAPILLOMA. CASE REPORT

Background. Esophageal squamous cell papillomas are rare epithelial lesions with malignant potential, diagnosed by upper gastrointestinal endoscopy. Their prevalence is from 0.01% to 0.43%. Objective. Description of rare esophageal squamous papilloma diagnosed during upper gastrointestinal endoscopy. Material and methods. A 38-year-old asymptomatic female patient underwent an upper gastrointestinal endoscopy. A growth described as an "esophageal polyp" was detected. The biopsy was performed and specimens were sent for histopathological study. Results. The final diagnosis of esophageal squamous papilloma was made due to histopathological study. Because of the malignant potential of these lesions, once diagnosed, early treatment is essential to prevent progression to esophageal carcinoma. Conclusions. Esophageal squamous papillomas are increasing in prevalence and have been shown to be potentially malignant. This argues the relevance of the problem and the need for widespread immunizations to control human papillomavirus infection.

20-year experience of treating esophageal polyps in children

Introduction. Gastrointestinal polyps are rare in newborn children, at the same time they are most common in children aged 2 to 10 years. Many aspects of endoscopic surgical treatment of polyps in children remain controversial, since they are not sufficiently covered in domestic and foreign literature.The aim was to conduct a retrospective analysis of surgical treatment of abdominal polyps of the esophagus in 52 children in the surgical and endoscopic department of the Regional Children's Clinical Hospital of Rostov-on-Don.Material and methods. For a 20-year period (2001-2020) and presentation of own material for the treatment of children with esophageal polyps based on modern pathogenetic views on the occurrence and development of this pathology. The main symptom of the disease in patients was dysphagia, which occurred in 79% of patients. Under anesthesia in the operating unit, patients underwent endoscopic polypectomy using diathermocoagulation, followed by covering the defect of the esophageal wall by clipping the edges of the mucous membrane.Results. The authors found that it is sufficient to perform polyp removal within the unaffected areas and continue antireflux therapy in order to get a full recovery of patients. Polyps of the transition zone between the esophagus and the stomach seem to have, among other things, also a morphological cause of their origin and development.The contact of two types of mucous membranes (esophagus and stomach) suggests, under certain conditions, the possibility of the development of polyps at the junction of two different morphological structure of mucous membranes. The benign nature of the polyps was confirmed histologically.Conclusion. The authors found that in the treatment of juvenile esophageal polyps, the suppression of gastroesophageal reflux disease should be considered mandatory both before and after surgery. There were no relapses of the disease.

S2818 Endoscopic Removal of a Symptomatic Benign Esophageal Sub-Mucosal Lesion

Introduction: The esophagus is a rare site for benign mucous duct cyst(mucocele). Mucoceles commonly occur from an obstructing salivary gland duct or rupture of the salivary gland. Therefore, mucoceles are most often found in the oral cavity. Symptomatic esophageal polyps or cysts have traditionally required surgical intervention. Endoscopic resection has become an option over the last few years and includes endoscopic mucosal resection or submucosal dissection. We present a case of an esophageal submucosal polypoid lesion that was removed endoscopically and revealed a rare and interesting pathology Case Description/Methods: A 70 year old female was referred for evaluation of reflux symptoms. During her initial outpatient visit she described worsening reflux symptoms and dysphagia. initially having dysphagia just to liquids but now progressing to solids. A trial of pantoprazole significantly improved her reflux symptoms but her esophageal dysphagia persisted. An upper endoscopy revealed a polypoid lesion at least 2.5 cm in length in the upper third of the esophagus (Figure a). A 2.5 cm heterogenous polypoid lesion without vascularity was seen on endoscopic ultrasound and doppler exam. Given lack of vascularity, the decision was made to attempt endoscopic resection. An endoloop was used to place at the base of the lesion, followed by resection(Figure b) Endoscopic appearance was most consistent with a fibrous polyp. Histologic study demonstrated the wall consisted of two muscle layers consistent with benign mucous cyst (Figure c). On follow up patients’ symptoms had resolved Discussion: A symptomatic esophageal polyp identified on an endoscopy carries an extensive differential diagnosis ranging from benign to malignant. Esophageal mucoceles are thought to occur due to recanalization of the upper digestive tract with subsequent coalescence of vacuoles. Histologically, benign mucous cysts are lined with two muscle layers. Prior cases have reported mucoceles emerging in the esophageal remnant directly following bypass surgery or secondary to tracheoesophageal fistula. We report a unique case of spontaneous emergence of mucocele without an obvious prior etiology or pre-disposing surgical intervention. Rarely, an esophageal cyst causes symptoms of dysphagia or regurgitation requiring removal. Endoscopic resection has gained popularity in recent years, due to the low rates of morbidity and mortality. Additional reports of esophageal mucoceles will help in understanding this rare condition better.Figure 1.: a: Endoscopic appearance of an esophageal submucosal lesion; b: nodule post-resection; c: Histologic study demonstrated the wall consisted of two muscle layers consistent with benign mucous cyst.

S2837 Giant Fibrovascular Esophageal Polyp Resected by Endoscopic Submucosal Dissection

Introduction: Esophageal lipomas are rare, accounting for 1% of all benign esophageal neoplasms. Fibrovascular polyps are a subset of esophageal lipomas that can present with dysphagia, hematemesis, melena and/or profound anemia. We describe a case of a giant esophageal fibrovascular polyp (GFVP) which was treated with endoscopic submucosal dissection (ESD). Case Description/Methods: A 62-year-old man presented for evaluation of a two-month history of dysphagia to solids and liquids, 4 kg weight loss, and melena. Examination revealed a chronically ill pale man with no palpable neck masses, a nontender, nondistended, soft abdomen, and melena confirmed by digital rectal exam. Blood work showed hemoglobin of 4.7g/dL, MCV of 78.1 fL and albumin of 3.6 g/dL. A Chest CT with IV contrast showed a soft tissue mass filling the entire length of the esophagus (Figure A). Differential diagnosis included esophageal carcinoma, pedunculated fibrovascular polyp, and leiomyomatosis. Barium esophagram showed smooth lobular defects filling the entire esophageal lumen (Figure B). Upper endoscopy and endoscopic ultrasound (EUS) revealed a near circumferential large stalk starting at the upper esophageal sphincter and diverging into 3 separate stalks measuring 15, 18, and 20 cm respectively with a small distal hematoma (Figure C). Because neither a 33mm snare nor endoloop could encircle the polyp heads, a technically complex ESD was performed using ERBE I knife and Endo Cut Q for submucosal incision. Standard SB knife was used for submucosal release before dissection with DryCut and the Olympus ITknife2. Hematoxylin & eosin staining confirmed the diagnosis of a GFVP. On one month follow up, the patient’s dysphagia had resolved completely, he had no recurrence of melena, and hemoglobin was stable. Discussion: Patients with GVFPs present with dysphagia, coughing, and a sensation of throat fullness. There are rare reports of large upper esophageal polyps regurgitating into the oropharynx and leading to subsequent asphyxiation. Prompt removal via cervicotomy or thoracotomy are the most common interventions, but upper endoscopy with ESD is a minimally invasive option that may facilitate improved recovery. ESD was chosen over endoscopic mucosal resection in this case due to multiple factors: less risk of intra and post procedural bleeding, technical difficulty for loop ligation since the polyp heads were large, and for superiority of ESD at achieving complete resection.Figure 1.: A: Sagital CT chest reveals entire esophageal lumen filled with soft tissue mass. B: Water soluble esophogram showing smooth lobar filling defects throughout the esophageal lumen. C: Endoscopic appearance of the large stalk of the multilobulated giant fibrovascular polyp inserting at the upper esophageal sphincter.

Giant fibrovascular polyps of the esophagus. Trans oral versus surgical approach. Case report and systematic literature review.

IntroductionGiant fibrovascular esophageal polyp is a rare benign intraluminal tumour. The aim of this study is to perform a review of the most recent literature in order to describe and analyse the current range of possible diagnostics and treatment strategies.Case reportWe present two cases of giant fibrovascular esophageal polyp treated with a combined minimally invasive transluminal approach at Sanchinarro University Hospital. Further, we perform a literature review.ConclusionWe present two cases of grant fibrovascular polyp submitted to minimally invasive transluminal approach. Furthermore, 54 original articles reporting 59 cases have been analysed. In the surgical group, an esophagotomy and polyp resection were performed in 31 (91 %) patients and a total esophagectomy in two patients (5,8 %). Severe morbidity occurred in two patients (5,8 %.) The median hospital stay was 9.25 days. A total of two (5,8 %) cases of recurrence have been registered. In the minimally invasive transluminal approach group, 27 patients had a polyp resection performed completely by endoscopy/transoral. There were no complications but there was one case of recurrence.ConclusionThe transluminal approach is safe and should be considered also in the treatment of large esophageal polyps.

Giant esophageal liposarcoma with squamous cell carcinoma resected via the cervical approach: a case report

BackgroundLiposarcoma is one of the most common soft tissue sarcomas, but is extremely rarely found in the esophagus. There have been no reports of esophageal liposarcoma together with superficial carcinoma of the esophagus. Here, we report a patient who underwent complete resection of esophageal liposarcoma with carcinoma via a cervical approach.Case presentationA 66-year-old man was diagnosed with an esophageal tumor 11 years ago, but he left it untreated. He presented to our hospital with progressive dysphagia and appetite loss since the previous year. Esophagogastroduodenoscopy (EGD) showed a large pedunculated submucosal tumor (SMT) originating at the esophageal entrance, extending to the gastroesophageal junction. Additionally, there was a superficial carcinoma on the surface of the SMT, 30 cm from the incisor teeth. Three-dimensional computed tomography (3D-CT) showed a giant elongated intraluminal tumor extending downwards from the cervical esophagus. We diagnosed a giant esophageal polyp accompanied by a superficial carcinoma and performed tumor resection via a cervical approach. The excised specimen consisted of a 23.0 × 8.5 cm polypoid mass. The final diagnosis by histopathological and immunohistochemical examination was well-differentiated liposarcoma and esophageal squamous cell carcinoma. He was discharged on postoperative day 14 with drastic improvement in his swallowing ability.ConclusionWe reported an extremely rare case of esophageal liposarcoma together with esophageal squamous cell carcinoma that was successfully resected through a small cervical incision.

Giant Fibrovascular Polyp – Amending Knowledge About a Rare Entity from a Known Benign to an Unknown Malignant Behavior

A giant fibrovascular polyp is a non-epithelial tumor of esophagus. It usually arises from the proximal esophagus behind the cricoid cartilage from the upper esophageal sphincter. These polyps were previously considered as benign non neoplastic intraluminal masses. However, with continuous studies and advanced testing by FISH (Fluorescence in situ hybridization) done in multiple cases worldwide, it has now been established that this entity is synonymous with well differentiated liposarcoma. Being proven to be a malignant entity now, care should be taken while treating such cases, as these will require an adequate resection margin during its surgical removal.&#x0D; This case report aims at enlightening the treating clinicians along with reporting radiologists and pathologists about this rare entity and to emphasize on correct management for patients’ benefit as it is known for recurrence and dedifferentiation. Also, being a sarcomatous lesion, it may lead to local and distant spread and prove fatal to the patient.&#x0D; Keywords: Giant fibrovascular polyp, liposarcoma, esophageal polyp

Recurrent giant fibrovascualr oesophageal polyp: Benefits and pitfalls of a multimodal approach.

Fibrovascular polyp of the cervical esophagus represents about 0.5% to 1% of all benign oesophageal tumours. Usually asymptomatic, when FP protrudes into the oesophageal lumen, this may cause respiratory obstruction and provoke dysphagia, vomiting, dyspnoea, and retrosternal pain. In this article, we describe a multimodal approach in the treatment of a complex recurrent FP, for which surgical resection represents the safer and less invasive procedure.

S2031 Esophageal Polyps Associated With Barrett’s Esophagus: Is This an Adenocarcinoma or Not?

INTRODUCTION: Barrett’s esophagus (BE) appears usually as a flat salmon-colored lesion. Esophageal adenocarcinomas associated with BE, traditionally appearing as an ulcer or a mass, seem to originate via the BE-dysplasia-carcinoma sequence. There is only a handful of reported cases of polypoid esophageal adenocarcinomas associated with BE. We describe a compelling case of incidental finding of BE with multiple esophageal polyps that turned out to be invasive adenocarcinoma. CASE DESCRIPTION/METHODS: A 60-year-old male with a past medical history of coronary artery disease and atrial fibrillation underwent laparoscopic cholecystectomy for chronic abdominal discomfort. His postoperative course was complicated by biliary leak; hence ERCP was performed and successful biliary stent placement was achieved. Two months later, an upper endoscopy was being performed for biliary stent removal when multiple 4 to 15 mm pedunculated and sessile polyps were identified in the distal esophagus (Figure 1). The upper endoscopy also revealed mucosal changes consistent with long-segment BE, C8-M10 per Prague criteria, a small hiatal hernia and multiple small gastric polyps. All large esophageal polyps were successfully resected with cold snare, after Eleview injection. The exception was a 10 mm polyp that was not liftable. Pathology reading of the resected polyps demonstrated low- and high-grade dysplasia along with intramucosal carcinoma (Figure 2). While the unresectable polyp revealed a moderately to poorly differentiated adenocarcinoma with HER2 positivity on FISH analysis. This was followed by an endoscopic ultrasound, which showed a 2 cm mass with irregular borders infiltrating the submucosa plus peritumoral lymph node involvement (Figure 3). The patient was referred to a multidisciplinary team of GI oncologists as well as a foregut surgeon for further management. DISCUSSION: Polypoid lesions of the esophagus are considered rare. To this date, there is no clear consensus on their management. We did a literature review, and we found 27 reported cases of polypoid dysplasia of the esophagus, 10 of them were having multiple lesions. The table is showing their characteristics and outcome. Through this case, we emphasize the association between these polypoid lesions and the adenocarcinoma of the esophagus. Hence, when esophageal polyps associated with BE are encountered, we are recommending their resection associated to multiple biopsies.Figure 1.: Upper Gastrointestinal endoscopy: Multiple polypoid lesions in the lower third of the esophagus, no signs of bleeding.Figure 2.: Image A, Esophageal Biopsy, High Magnification: Intestinal metaplasia with nuclear enlargement, loss of nuclear polarization, occasional prominent nucleoli, and increased apoptosis, as well as crypt fusion and cribriforming; changes consistent with high-grade dysplasia. Image B: Sheets of infiltrating malignant cells at medium magnification infiltrating the lamina propria.Figure 3.: Upper Endoscopic Ultrasonography: Hypoechoic mass in the lower third of the esophagus, the lesion is non circumferential, the borders are irregular, 5 mm in thickness with submucosal invasion.

S1916 Liposarcoma Associated with Fibrovascular Polyp of the Esophagus

INTRODUCTION: Liposarcomas arise from adipocytes of soft tissue however usually in the body wall or extremities. Gastrointestinal involvement is rare. CASE DESCRIPTION/METHODS: 72-year-old man with a history of GERD presented with progressive dysphagia for a few weeks. He also reported an unintentional weight loss of about 35 lbs. He denied any family history of esophageal or gastric cancer. He denied any tobacco or alcohol use. He underwent an upper endoscopy which showed a large 14 cm pedunculated polyp in the esophagus extending from the upper esophageal sphincter (UES) to about 2 cm above the gastroesophageal junction occupying about 70% of the esophageal lumen, suspicious for a fibrovascular polyp (Figure 1). The polyp was resected by endoscopic submucosal dissection of the wide base, about 1 cm from the UES (Figures 2 and 3). Following the procedure, the patient's diet was advanced and he was discharged home. Histological evaluation revealed a polypoid lesion with a core of fibrovascular connective tissue and normal overlying squamous epithelium. Small areas of atypical lipomatous tissue was seen with amplified expression of MDM2 which was consistent with the diagnosis of a well-differentiated liposarcoma. The base of the polyp was clear of any malignant cells. DISCUSSION: Fibrovascular polyps (FVP) are benign tumors of the esophagus usually composed of a combination of fibrous, vascular and adipose tissue. We present a case of an FVP with malignant progression of the adipose tissue within the polyp. While this is a very rare occurrence, the goal of endoscopic resection is to resect the polyp with an intact base for histological evaluation of the margin.Figure 1.: Esophageal Polyp in Middle Third of Esophagus.Figure 2.: Upper third of esophagus during Mucosal Resection.Figure 3.: Polyp Retrieval During Resection.

RECENT TRENDS IN THE HISTOLOGICAL SPECTRUM OF GASTROINTESTINAL POLYPS

INTRODUCTION: Polyps are projections or elevations from the surface of mucosa. Histopathological examination of polyps is very important because of the risk of malignancy associated with certain polyps. The aim of this study is to analyse spectrum of polyps in different locations of Gastrointestinal tract. MATERIALS AND METHODS: This is a descriptive study conducted in Department of Pathology, Government Kilpauk Medical College for a period of 3yrs. 156 cases were included. Polyps were analysed based on age, sex, location, endoscopic appearance and histologic findings. RESULTS: Gastrointestinal polyps are most common in males(61.5%) and in age group of 46.60years(37.8%). Most of the polyps are sessile(73.1%) and occur in the large intestine(41.6%). The most frequent polyps based on locations are Squamous papilloma in esophagus , hyperplastic polyp in stomach, inflammatory polyp in small intestine and adenomatous polyp in large intestine. DISCUSSION AND CONCLUSION: The results were compared with other similar studies. Most of the study results correlated with study by Gurung P et al. Esophageal polyps correlated with study by Patit et al. Inflammatory polyps are the predominant Sessile polyps, Hyperplastic polyps are the predominant diminutive polyp and adenomatous polyps are the predominant pedunculated polyps. This study provides information regarding most frequent polyps based on locations and gross appearance and helps to find the changing trends in the incidence of polyps.

O10 GIANT ESOPHAGEAL POLYP PROTRUDING THROUGH THE MOUTH: A RARE CASE

Abstract Aim Giant esophageal polyps are a relative rare and benign entity, which can lead to major complications. Our knowledge about their pathology and management originates from scattered case reports. Our aim is to report the clinical presentation and management of this rare case in order to enrich the current literature. Background &amp; Methods Large pedunculated esophageal polyps are a rare entity encountered in clinical practice. The majority of these polyps are located near the upper esophageal sphincter or upper esophagus. They are slowly growing and asymptomatic. Most common clinical symptoms, associated with polyp size, include dysphagia, chest pain, regurgitation and, rarely, acute respiratory distress. Histology reveals benign submucosal tumors with fibrous and vascular components, covered by normal squamous cells, in most cases. Malignant transformation of these polyps has been infrequently described. Surgical approach, either with endoscopic resection or with open surgery, is the treatment of choice and recurrence is extremely uncommon. A review of current literature was conducted, followed by presentation of our rare case. Results A 50 year-old woman with clear medical history presented with a 3-month history of dysphagia and endoscopy revealed a large esophageal polyp extending from the upper esophageal sphincter to the lower esophageal sphincter. The initial attempt of endoscopic resection of the polyp led to regurgitation and intraoral prolapse of the polyp, causing respiratory distress. The patient was transferred to the ENT operation room and an orotracheal intubation was performed. The tumor was successfully removed transorally after ligation of its stem. Histopathology showed an inflammatory fibroid polyp (IFP) and postsurgical follow-up revealed no recurrence of the mass. Conclusion Giant IFPs are an extremely rare entity among upper esophageal polyps and the pathogenesis of these tumors remains poorly understood. Life threatening regurgitation of the polyp causing respiratory distress is an uncommon complication demanding urgent surgical approach. Once diagnosed, these benign tumors can be removed either with open surgery or endoscopic resection depending on the location and the size of the tumor. The impressive size of these polyps renders them a challenge for surgeons and endoscopists, whose cooperation is often in need.

Esophageal Hematoma Mimicking a Large Esophageal Polyp: A Diagnostic Clue of Acquired Hemophilia A

Esophageal Hematoma Mimicking a Large Esophageal Polyp: A Diagnostic Clue of Acquired Hemophilia A

Endoscopic resection of a giant fibrovascular esophageal polyp by use of a scissor-type knife.

Endoscopic resection of a giant fibrovascular esophageal polyp by use of a scissor-type knife.

First Characterization with Ultrasound Contrast Agent of a Fibrovascular Polyp Before Its Endoscopic Resection: A Case Report (with Videos).

We described for the first time the contrast enhancement of a giant fibrovascular esophageal polyp using ultrasound contrast agent, Sonovue® (Bracco, Milan, Italy) during echoendoscopy. Fine Doppler was unsuccessful in showing vascularization due to the mobile characteristic of the tumor. In contrast, via Sonovue®, tissue microcirculation was highlighted inside the entire head of the polyp, leading to better appreciate the risk of bleeding related to its resection. In a second part, we showed the feasibility of classic polypectomy for this giant polyp (5×5 cm) without complication and results of control endoscopy at 3 months. The present case is summarized in a video.

Coughing up a Polyp: A Rare Cause of Dysphagia!

Fibrovascular polyps are rare, benign intraluminal lesions composed of fibrous, vascular and adipose tissues. They tend to be large and pedunculated and most commonly arise in the proximal esophagus. The incidence is higher in men and typically present in the 6th or 7th decade of life. A 74-year-old male presented with intermittent symptoms of dysphagia and episodes of choking in which he would cough up a mass and then swallow it again. He denied any odynophagia or respiratory distress between the episodes. There were no reports of weight loss or anemia. Upper endoscopy showed a proximal cervical submucosal lesion. A CT scan revealed a low-density lesion within the superior esophagus and a barium swallow showed a large pedunculated filling defect with a visible stalk extending superiorly within the upper esophagus. Further examination by endoscopic ultrasound showed a long esophageal polyp from the area immediately below the vocal cords extending down about 5cm. The polyp was estimated to be at the level of the upper esophageal sphincter area/hypopharynx (Figure 1). The patient was ultimately referred to ENT for endoscopic resection of the hypopharyngeal mass. The polyp, measuring about 6cm in length and 3cm in width, was resected en bloc (Figure 2). The patient tolerated the procedure well and was discharged the following day with only moderate odynophagia that soon resolved. Pathology was benign with the polyp described as a fibroepithelial lesion with focal surface erosion, reactive epithelial changes, and marked vascular congestion. Fibrovascular polyps are rare, benign polyps. While the exact etiology is unknown, it is thought that these types of polyps arise from redundant mucosal folds that slowly elongate over time due to constant traction from peristaltic activity. They tend to be slow growing and are often able to reach a large size before discovery. The most common presentation is dysphagia followed by globus sensation, but they can also cause anemia, weight loss and odynophagia. The most severe complication is regurgitation of the polyp into the oral cavity which can lead to asphyxiation. Despite different imaging modalities, these polyps are often misdiagnosed or missed, especially on EGD where they can resemble normal mucosa or lay flat against the lumen. Prompt removal by endoscopic or surgical resection is important to prevent potentially fatal complications.1815_A Figure 1. Imaging1815_B Figure 2. fibrovascular polyp