Endoscopic removal of a giant double-headed fibrovascular esophageal polyp

Abstract

Figure 1. A, Upper-GI endoscopic view of giant fibrovascular polyp arising from the upper esophagus just near the level of the cricopharyngeus. Note huge submucosal appearance that occupies approximately the whole esophagus and has a smooth overlying mucosa of the body. BE , General scheme of the removal of the giant esophageal fibrovascular polyp. B, C, Two endoloops, one after another, applied at the level of the ramification of the polyp body. The first portion of the polyp is cut. D, E, Another 2 endoloops are placed at the very base of the stalk and securely tightened. The remaining portion of the polyp is resected. F, First nylon endoloop is placed at the level of the ramification of the polyp body and tightened securely. The scope is then exchanged for a double-channel therapeutic gastroscope. Grasping forceps are used to manipulate the polyp in view of the difficulty of placing the edematous polyp through the second loop. G, Resection of the first 75-mm portion of the giant fibrovascular polyp above 2 endoloops in endocut mode with the 25-mm electrosurgical snare. H, The second loop is applied right over the first loop and tightened strongly, mainly to prevent possible profuse bleeding and perforation. The second portion of the polyp is removed above the loops. Resected giant fibrovascular polyp. I, Overall appearance of polyp. Total length, 13,5 cm; distal head, 32 mm in diameter with 2 ulcerations on the apex; proximal head, 25 mm in diameter. J, Cross-section at the level of the base of the polyp, 18 mm in diameter (note the large vessels). K, Ligated 10-mm stalk stump of the polyp left in place. L, M, Histologic appearance showing mixture of fibrous and adipose tissues accompanied by abundant network of large vessels, covered by normal squamous epithelium. (L, H&E, orig. mag. Â5; M, H&E, orig. mag. Â20.) N, Surveillance gastroscopic view at 18 months revealing no changes of esophageal wall and mucosa, with no evidence of recurrence.

Siamese twin polyps: exploring the nature and management of the exceptionally rare bilobed colonic polyps

“…1 Alternatively, multiple bilobed polyps have been reported in the ureters as well as the oesophagus. [2][3][4] Similar to the previous case report, the unique features of the bilobed polyp found in our patient includes a pedunculated bifid appearance arising from a common stalk; (Fig. 1).…”

Endoscopic resection of a giant fibrovascular esophageal polyp by use of a scissor-type knife

“…3 Recently, endoscopic resection with ultrasonic shears, a needle-type knife, and an electrosurgical snare has been performed. [3][4][5] The Scissortype knife facilitates grasping the pedicle and enables simultaneous excision and coagulation while maintaining a stable view by use of only a single device. Furthermore, the SB knife's capacity to grasp, assess, and then excise and coagulate target tissues enables safe and easy resection of large polyps with their stalk, which is challenging when the snare technique is used.…”