Advanced endoscopic resection using endoscopic submucosal dissection technique to resect a giant, lumen-occluding esophageal polyp

Fibrovascular polyps tend to appear as lesions of up to 7 cm in length, and cause symptoms that range from dysphagia to episodes of asphyxiation due to prolapse into the respiratory tract [1] [2]. Traditionally, surgical treatment is performed because there is a risk of hemorrhaging during endoscopic resection [3].

A 48-year-old woman with dysphagia and progressive retrosternal pain for 6 months underwent an upper endoscopy, which showed an esophageal polyp of 12 cm in length occupying 80 % of the lumen ([Fig. 1]). The histology confirmed a fibrovascular polyp. 

Fig. 1 Esophagogram revealed an esophageal polyp, 12 cm in length and occupying 80 % of the lumen.

We carried out another upper endoscopy under sedation. First, we identified the pedicle. Clips were placed, and the submucosal dissection was initiated sequentially with a needle-knife, being careful to identify all of the feeder vessels. Selective hemostasis was performed with coagulation forceps (Coagrasper; Olympus, Tokyo, Japan) in endocut mode. After careful dissection of all tissue, the polyp was completely removed in one piece ([Video 1]). Peroral extraction was carried out using a net ([Fig. 2]). The pathology report confirmed a fibrovascular polyp.

Video 1 Endoscopic submucosal dissection of a giant, lumen-occluding esophageal polyp.

Fig. 2 Peroral extraction of the resected polyp.

The postoperative course occurred without any incidents, and endoscopic follow-up 2 months later showed a scar with no signs of recurrence.

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• References

• 1 Lee SY, Chan WH, Sivanandan R. et al. Recurrent giant fibrovascular polyp of the esophagus. World J Gastroenterol 2009; 15: 3697-3700
• 2 Park JS, Bang BW, Shin J. et al. A case of esophageal fibrovascular polyp that induced asphyxia during sleep. Clin Endosc 2014; 47: 101-103
• 3 Mishra PK, Goel N, Saluja SS. et al. Management of giant fibrovascular polyp of esophagus. Am Surg 2012; 78: E538-E540