Prevalence of esophageal squamous papilloma (ESP) and associated cancer in northeastern France

Abstract

Background and study aims: Esophageal squamous papilloma (ESP) is a rare lesion. The aims of this study were to assess the prevalence of ESP in northeastern France and the risk of associated squamous cell carcinoma (SCC). Patients and methods: The charts of 78 patients who were diagnosed with ESP between January 2005 and February 2013 at three hospitals in northeastern France were reviewed. Results: A total of 55 305 endoscopies were performed and 78 ESP were diagnosed (0.01 %). Patients with ESP included 44 males (56.4 %), 34 females (43.6 %); median age 50, interquartile range (IQR) 19 – 86. Median follow-up was 21 months (IQR 0 – 91 mo) and median time between first and second endoscopy was 7 months (IQR 0.5 – 74 mo). Of the total number of patients, 35 (44.9 %) had a second endoscopy. Main endoscopy indication was dyspepsia (24.4 %). Most ESP were isolated (93.6 %) and located at distal esophagus (27 cm, IQR 16 – 40 cm). Median size was 3 mm (IQR 1 – 20 mm). ESP-associated endoscopic lesions were hiatal hernia in 12 patients and esophagitis in 11 patients. Endoscopic treatment was mainly excisional biopsies (60.3 %). Human papillomavirus (HPV) was not detected in the 6 patients with available data. Low dysplasia was found in 2 ESP. During follow-up endoscopies, 2 SCC were detected in 2 different patients; the first SCC was located at the previous resection site of the ESP and the second had a different location. Prevalence of associated cancer was 1.3 %. Conclusion: Prevalence of ESP in northeastern France is similar to that previously reported. Endoscopic findings were also broadly the same as in previous reports. The occurrence of dysplasia and SCC should strongly encourage the endoscopist to totally remove the ESP and to start an endoscopic surveillance, given the potential risk of malignant transformation.

Analyzing esophageal squamous cell papillomas for the presence of human papilloma virus

“…When detected at endoscopy, complete removal is recommended in order to disregard the possibility of malignant transformation (6). There is a marked geographic and ethnic variation in the incidence.…”

Squamous Cell Papilloma of the Esophagus: A Case Series Highlighting Endoscopic and Histologic Features

“…Complications with squamous cell carcinoma (SCC) have been reported [3][4][5][6]; however, the small absolute number of cases makes drawing any associations or conclusions between ESP and SCC difficult [12]. Review of the literature seems to suggest malignant potential appears highest in cases where the patient is symptomatic and has multiple lesions (papillomatosis), or a particularly large lesion [5,6]. e gold standard for evaluation is biopsy.…”

“…e gold standard for evaluation is biopsy. ere are various proposed therapies for squamous papillomas including forceps biopsy resection, cautery, radiofrequency ablation, mucosectomy for larger lesions, and potentially esophagectomy if presentation is extreme and does not respond to more conservative therapy [4,5,11,13,14]. Future research is needed regarding treatment and surveillance for these lesions.…”

A Small Esophageal Polyp

“…ESP is usually a benign epithelial lesion with a reported prevalence ranging from 0.01% to 0.45%. 1,2 The pathogenesis of ESP is still unclear, but chronic mucosal irritation owing to acid reflux disease or minor trauma, and human papilloma virus infection may contribute to its development. 1 The most common endoscopic features of ESP under conventional white-light endoscopy include a whitish color, exophytic growth, and a wart-like shape.…”

“…1,2 The pathogenesis of ESP is still unclear, but chronic mucosal irritation owing to acid reflux disease or minor trauma, and human papilloma virus infection may contribute to its development. 1 The most common endoscopic features of ESP under conventional white-light endoscopy include a whitish color, exophytic growth, and a wart-like shape. 3 The typical histologic feature is finger-like projections of hyperplastic squamous epithelium surrounding a connective tissue core containing small blood vessels.…”