Esophageal Pyogenic Granuloma: Endosonographic Findings and Endoscopic Treatments

Abstract

Pyogenic granuloma is a benign inflammatory vascular lesion, mainly found in the skin and oral mucosa. A few cases of pyogenic granuloma in the gastrointestinal tract have been reported, and the esophagus was the main site in these cases. These patients were diagnosed with pyogenic granuloma after they underwent upper endoscopy and biopsy. Endoscopic resection is a favorable treatment option for esophageal pyogenic granuloma. Recently, we observed characteristic endosonographic findings in two cases with esophageal pyogenic granuloma, which were then treated successfully by endoscopic resection.

Morphological Changes in a Pyogenic Granuloma of the Esophagus Observed over Three Years

“…Macroscopically, esophageal pyogenic granulomas are observed as protruding tumors or submucosal tumor-like lesions (1). The surface of these lesions ranges from pale pink to dark red in color, and the masses are sometimes accompanied by whitish or yellowish exudates (8).…”

“…Seoung et al reported two cases of esophageal pyogenic granulomas showing homogeneously hyperechoic internal density on endoscopic ultrasonography and speculated that hyperechoic areas reflect the presence of abundant blood vessels, as seen in cases of hemangiomas (1,11). However, Rolanda et al reported a case involving different ultrasonographic features of a hypoechoic mass (10).…”

“…The lesion usually occurs on the skin as well as the mucosal surface of the oral cavity (1)(2)(3). The occurrence of pyogenic granuloma in the gastrointestinal tract is infrequent, with only approximately 50 cases reported to date (1).…”

Clinical and endoscopic features of gastric pyogenic granuloma

“…To our knowledge, approximately 65 cases of PG in the alimentary tract (other than in the oral mucosa) have been published in the literature. The reports have described 19 cases of PG in the esophagus [10–14]; five cases in the stomach; 20 cases in the small intestine [10,11,14–18]; 19 cases in the colon [10,19–25]; one case in an unidentified area of the alimentary tract [26]; and one case in the common bile duct [1]. The patients' ages ranged from 1.5 years to 82 years (mean age, 49.97 years) and 56.36% of the patients were male.…”

“…Complete excision is reportedly the optimal management for GI tract PG [4,29]. Endoscopic resection is the most favorable treatment for GI tract PG and has been reported in 63.33% of patients [3–7,10,12–19,21,23,24]. Only one patient developed perforation at the site of polypectomy and then underwent surgical repair; however, he recovered and was discharged 5 days later [23].…”