Successful endoscopic removal of a giant upper esophageal inflammatory fibrous polyp

Abstract

Giant esophageal inflammatory fibrous polyp (especially > 17 cm in size) is seen rarely. Endoscopic removal has been reported rarely because the procedure is technically demanding and the hemostasis is difficult to ascertain. Here, we describe a case of a giant upper esophageal inflammatory fibrous polyp that was resected successfully by endoscopy.

Fibrovascular Polyp of the Esophagus: A Case Series

“…7 Endoscopic excision is usually done for small polyps, though a large polyp has been excised successfully. 9 Cervical esophagotomy is the most common approach for surgical excision where esophagus was approached through a left cervical incision. Complete sub mucous excision of the polyp was performed, and the edges of the mucosal defect were approximated with absorbable sutures, and the esophagotomy was closed primarily.…”

Endoscopic resection of a giant fibrovascular polyp of the oesophagus with the assistance of ultrasonic shears

“…Open excision via a transcervical/transthoracic incision is recommended for polyps longer than 8 cm or those with a thick vascular pedicle; in rare cases, thoracotomy6 or oesophagectomy9 10 may be required for very large lesions. Endoscopic resection is recommended for small polyps with a thin pedicle although lesions of up to 17 cm have been successfully removed endoscopically 11. To date, there are only five reports of endoscopic resection and techniques for removal include the use of an electrosurgical snare,11 12 Endoloop,13 14 Endo GIA stapler15 and Nd:YAG laser 16.…”

“…Endoscopic resection is recommended for small polyps with a thin pedicle although lesions of up to 17 cm have been successfully removed endoscopically 11. To date, there are only five reports of endoscopic resection and techniques for removal include the use of an electrosurgical snare,11 12 Endoloop,13 14 Endo GIA stapler15 and Nd:YAG laser 16. In our case, we were able to remove the entire polyp endoscopically using a Harmonic ACE (Ethicon, UK) to divide the thick vascular pedicle, and muscle relaxant to aid delivery.…”

Unusual presentation of a giant benign inflammatory polyp in the upper esophagus

“…This risk can be minimized with adequate insufflation and distension of the esophagus. The site of snare polypectomy should be kept away from the base of stalk to prevent esophageal perforation [10] . Our patient underwent a left cervical exploration with resection of the mass due to its large size.…”