Abstract
Background
Giant fibrovascular esophageal polyps are rare benign intraluminal tumors that originate from the submucosa of the cervical esophagus [Owens et al. (JAMA 103: 838-842, 1994), Totten et al. (JAMA 25:606–622, 1953)]. Due to their indolent course, these tumors tend to reach enormous proportions before patients develop symptoms. Accurately diagnosing these tumors is difficult, as endoscopy may miss 25% of these lesions because these polyps exhibit normal intact esophageal mucosa [Levine et al. (JAMA 166: 781–787, 1996)].
Methods
Surgical resection has been the treatment of choice. We present a video that illustrates the feasibility of an endoscopic approach.
Technique/case
A 62-year-old man presented to our clinic with a pedunculated esophageal mass. During this time, he developed progressive dysphagia to solid foods. A complete workup confirmed the presence of a giant polyp and endoscopic resection under general anesthesia was planned. Using an endoscopic snare-technique, a 16 cm × 3 cm polyp was amputated and retracted out of the oropharynx. Upon repeat endoscopy a second 7 cm × 3 cm polyp was discovered originating proximal to the larger polyp. Again, removal of this polyp was attempted using a snare-technique. Following amputation of the polyp, a broad-based component of the polyp remained. Given its proximal location in the esophagus, we were able to use a snare to pull the broad base of the remaining polyp into the oropharynx and remove it at its origin. Postoperative endoscopy and endoscopic ultrasound confirmed that the polyps were completely removed and the muscular resection bed was hemostatic. Clinically, the patient’s symptoms resolved and he encountered no adverse sequela as a result of the operation.
Conclusion
Giant fibrovascular esophageal polyps are rare benign intraluminal tumors that can lead to obstructive symptoms. Surgical resection is the treatment of choice, and may be possible with an endoscopic approach. An endoscopic snare technique can be used to resect these lesions while minimizing patient morbidity.
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References
Owens JJ, Donovan DT, Alford EL et al (1994) Life-threatening presentations of fibrovascular esophageal and hypopharyngeal polyps. Ann Otol Rhinol Laryngol 103:838–842
Totten RS, Stout AP, Humphreys GH et al (1953) Benign tumors and cysts of the esophagus. J Thorac Cardiovasc Surg 25:606–622
Levine MS, Buck JL, Pantongrag-Brown L, Buetow PC, Hallman JR, Sobin LH (1996) Fibrovascular polyps of the esophagus:clinical, radiographic, and pathologic findings in 16 patients. AJR 166:781–787
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Dr. Swanstrom is on the scientific advisory boards of Olympus and Boston Scientific. Dr. Reavis is a consultant for Boston Scientific, Endogastric Solutions, and Stryker, and receives teaching or advisory honoraria from Ethicon, Mederi, Gore, and Apollo. These disclosures are not related to the current study. Drs. Ward, Beard, Teitelbaum, Sharata, and Dunst have no conflicts of interest or financial ties to disclose.
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Ward, M.A., Beard, K.W., Teitelbaum, E.N. et al. Endoscopic resection of giant fibrovascular esophageal polyps. Surg Endosc 32, 1066–1067 (2018). https://doi.org/10.1007/s00464-017-5664-0
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DOI: https://doi.org/10.1007/s00464-017-5664-0