Department of Surgery, Providence Portland Medical Center, Portland, OR, USA.
Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 4805 NE Glisan St., Suite 6N60, Portland, OR, 97213, USA.
Surg Endosc. 2018 Feb;32(2):1066-1067. doi: 10.1007/s00464-017-5664-0. Epub 2017 Jun 22.
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)].
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.
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.
巨大纤维血管性食管息肉是一种罕见的良性腔内肿瘤，起源于颈段食管的黏膜下层[Owens 等人（JAMA 103: 838-842, 1994），Totten 等人（JAMA 25:606-622, 1953）]。由于其惰性病程，这些肿瘤往往在患者出现症状之前就已经长到巨大的尺寸。准确诊断这些肿瘤很困难，因为内镜检查可能会漏掉 25%的这些病变，因为这些息肉表现出正常完整的食管黏膜[Levine 等人（JAMA 166: 781-787, 1996）]。
手术切除一直是治疗的首选方法。我们展示了一段视频，说明了内镜方法的可行性。
技术/病例：一名 62 岁男性因带蒂食管肿块就诊于我们的诊所。在此期间，他逐渐出现进行性固体食物吞咽困难。全面检查证实存在巨大息肉，并计划在全身麻醉下进行内镜下切除。使用内镜套扎技术，切除了一个 16 厘米×3 厘米的息肉，并将其从口咽部缩回。再次进行内镜检查时，发现了另一个 7 厘米×3 厘米的息肉起源于较大息肉的近端。再次尝试使用套扎技术切除这个息肉。切除息肉后，仍有一个宽基底的息肉残端。由于其位于食管的近端，我们能够使用套扎器将宽基底的残端拉入口咽部，并从其起源处切除。术后内镜和内镜超声检查证实息肉完全切除，肌肉切除床止血良好。临床上，患者的症状得到缓解，且无手术相关的不良后果。
巨大纤维血管性食管息肉是一种罕见的良性腔内肿瘤，可导致阻塞症状。手术切除是首选治疗方法，可能通过内镜方法实现。内镜套扎技术可用于切除这些病变，同时最大限度地降低患者的发病率。
