Esophageal polyps in pediatric patients undergoing routine diagnostic upper gastrointestinal endoscopy: a multicenter study

Abstract

Esophageal polyps are uncommon findings in pediatric patients, and reports have been limited to case reports. Esophageal polyps have been previously ascribed to esophagitis secondary to gastroesophageal reflux, medications, infections and recurrent vomiting. They have been associated with underlying conditions such as hiatal hernia, Barrett's esophagus, eosinophilic esophagitis and Crohn's disease. Presenting complaints of children with esophageal polyps have included vomiting, dysphagia, hematemesis and abdominal pain. The aim of this paper is to characterize the incidence, clinical presentation and progression, histologic subtypes and associated mucosal abnormalities in children with esophageal polyps. A retrospective multicenter study was performed at four institutions identifying diagnosis of esophageal polyps in pediatric patients (<21 years). Information was obtained from patient charts, endoscopy reports and histopathology reports. Specimens and slides were examined by experienced pediatric pathologists for all included cases. Esophageal polyps were identified in 13 patients (9 M) from 9438 esophagogastroduodenoscopies (0.14%). Mean age of subjects was 9.2 years. Vomiting was the most common indication for endoscopy. Polyp location was at the gastroesophageal junction in 7 of the 13 cases. Most polyps were inflammatory (n = 7). Esophagitis was noted in 69% of those with esophageal polyps. Repeat endoscopies in six patients at a mean interval of 8 months noted persistence of polyps in all six patients. This paper is the first to characterize esophageal polyps in pediatrics. These polyps are rare in children and often are associated with esophagitis. Presenting complaints seem to vary by age. Polyps did not consistently change with either time or acid suppression. The optimal management strategy has yet to be defined and likely depends on the underlying pathophysiologic process.

Multiple Esophageal Hyperplastic Polyps in a Nigerian Woman

“…The optimal treatment strategy is still to be defined. While some anecdotal reports showed regression of polyps after a course of anti-secretory therapy such as proton pump inhibitors [5,18], others have not demonstrated regression [14,18,22]. The minimum duration of anti-secretory therapy for polyp regression has also not been established.…”

Unusual Endoscopic Findings in Children

“…4,8,12 In our series, we found 3 lesions, corresponding to an estimated frequency of 0.14%, which is consistent with some reports. 1–3 In all patients, the main indication for upper digestive endoscopy was vomiting associated with other complaints, such as pyrosis and epigastric pain. The first one was an inflammatory lesion that we ascribed to a gastroesophageal reflux disease according to patient's clinical history and endoscopic findings (grade A esophagitis).…”

“…1–3 In children, the clinical features of gastrointestinal polyps depends on location and number of lesions. Considering the rarity of these lesions, the management of this patients is an increasing challenge for pediatric gastroenterologists and usually involves a multidisciplinary approach, especially in children with polyposis syndromes or a family history of gastrointestinal polyps.…”

“…1–3,5 These pseudotumoral formations can be identified using an imagistic (barium meal and computed tomography) or an endoscopic approach. Esophageal polyps are frequently associated with gastroesophageal reflux disease, hiatal hernia, Barrett esophagus, eosinophilic esophagitis, Crohn disease, or type 1 neurofibromatosis, whereas gastric polyps are associated with Helicobacter pylori infection and chronic proton pump inhibitors (PPIs) use.…”

Paediatric gastrointestinal neoplasia

“…Finally, oesophageal polyps may be encountered but are distinctly uncommon; in a review of over 9000 upper GI endoscopies, only 13 were identified, being mainly inflammatory, followed by squamous papillomas and rare hamartomas, the majority affecting the gastro-oesophageal junction. 10 …”