Endoscopic resection of a giant fibrovascular polyp of the oesophagus with the assistance of ultrasonic shears

Esophageal fibrovascular polyp is rare in esophageal neoplasms and usually very large. Here, we present a case of giant esophageal fibrovascular polyp. The patient had dysphagia and choking sensation at presentation. She underwent positron emission-computed tomography (PET-CT), endoscopy, endoscopic ultrasonography, and fine needle aspiration. She was clinically diagnosed as having an esophageal benign tumor and underwent endoscopic submucosal dissection. The polyp was successfully resected; however, the process was very difficult, and the lesion was too large to pass through the upper esophagus. Finally, we removed the lesion surgically. Fibrovascular polyps are often large, and if endoscopic resection is chosen, it is necessary to consider the difficulties that may be encountered during resection, before initiating treatment.

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P157 GIANT PEDUNCULATED OESOPHAGEAL LIPOSARCOMAS: A CASE AND REVIEW OF RESECTION TECHNIQUES

Diseases of the Esophagus ◽

10.1093/dote/doz092.157 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

Y Annalisa Ng ◽

June Lee ◽

Jinlin Lin ◽

Siok Siong Ching ◽

S Andrew Wong

Keyword(s):

Endoscopic Resection ◽

Cervical Oesophagus ◽

Endoscopic Techniques ◽

Guiding Principle ◽

Large Size ◽

Rare Tumours ◽

Ultrasonic Shears ◽

Pedunculated Polyp ◽

Distal Aspect ◽

Tumour Characteristics

Abstract Aim Liposarcomas are rare causes of oesophageal tumours, accounting for <1% of tumours. We present a case of giant oesophageal liposarcoma with a discussion focusing on resection techniques. Background & Methods A 54-year-old gentleman presented to the hospital with symptoms of anaemia and weight loss for 3 months. A CT scan and oesophagogastroduodenoscopy (OGD) showed a giant, pedunculated polyp extending from the cervical oesophagus to cardioesophageal junction (CEJ) with mucosal ulceration at its distal aspect. Endoscopic ultrasound (EUS) revealed a 24 x 6 cm submucosal pedunculated mass with lipomatous regions and core biopsy only showed rare groups of spindle cells with no malignancy. Resection was advised in view of occult bleeding from polyp and endoscopic resection was deemed unsuitable in view of a highly vascular stalk and large size of polyp. He underwent surgical resection via a left cervical oesophagostomy with gastrostomy for polyp retrieval. Final histology showed a dedifferentiated liposarcoma arising within a giant fibrovascular polyp. Results Open surgery has classically been standard of treatment, but endoscopic resection is less morbid and invasive. Endoscopic techniques described include using a retraction suture followed by division of the polyp stalk using ultrasonic shears, using a snare, endoscopic submucosal dissection (ESD), and application of hemoclips following diathermy. In cases where endoscopic resection is not feasible, surgery such as oesophagostomy, oesophagectomy and laparotomy for resection and retrieval of the tumour have been described. Main reason for oesophagectomy was the presence of a submucosal (rather than polypoid, pedunculated) large tumour. For resection via oesophagostomy, stalk transection can be performed via stapling devices or suture ligation. Conclusion Giant oesophageal liposarcomas are very rare tumours. Such tumours are usually polypoid, arising from a pedicle in the proximal oesophagus. Resection techniques have shifted from oesophagectomy to less invasive means such as endoscopic resection or oesophagostomy. Decision on type of resection technique depends on tumour characteristics and location; with the guiding principle being resection with clear margins in order to prevent local recurrence.

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Endoscopic resection for giant oesophageal fibrovascular polyp

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2020.0008 ◽

2020 ◽

Vol 102 (4) ◽

Author(s):

N Acar ◽

T Acar ◽

F Cengiz ◽

B Şuataman ◽

C Tavusbay ◽

...

Keyword(s):

Endoscopic Resection ◽

Outpatient Clinic ◽

Complete Resection ◽

Polypoid Mass ◽

Fibrovascular Polyp ◽

Related Mortality

A fibrovascular polyp is a rare benign pseudotumour of the oesophagus and hypopharynx. Although patients usually present with dysphagia, aspiration related mortality may occur. If the tumour is too large and/or located in the proximal oesophagus, it may protrude from the mouth. The general approach to treatment is complete reconstruction with cervicotomy. We present our experience of a giant oesophageal fibrovascular polyp that was protruding from the mouth and treated with endoscopic resection. A 55-year-old man was admitted to our outpatient clinic complaining of a mass protruding from his mouth when he coughed. Endoscopy and bronchoscopy both revealed a 15–18cm long polypoid mass originating from the proximal oesophagus (at the level of the hypopharynx). Complete resection was performed via endoscopy.

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Endoscopic Resection of the Olecranon and Pre-Patellar Bursa

Swiss Surgery ◽

10.1024/1023-9332.7.3.121 ◽

2001 ◽

Vol 7 (3) ◽

pp. 121-125 ◽

Cited By ~ 9

Author(s):

Nussbaumer ◽

Candrian ◽

Hollinger

Keyword(s):

Endoscopic Resection ◽

Postoperative Komplikationen

Fragestellung: Gemäss Literatur treten nach chirurgischer Behandlung entzündlich veränderter Bursae präpatellar oder am Olecranon in rund 20% der Fälle Narbenbeschwerden auf. Die Frage ist, ob durch ein endoskopisches Vorgehen, welches erstmals 1990 beschrieben wurde, die Häufigkeit dieser Komplikationen reduziert werden kann. Methode: Im Rahmen einer prospektiven Studie wurde bei 13 Patienten mit einer Bursitis ein endoskopisches Bursa-shaving durchgeführt. Alle Patienten wurden drei Wochen und sechs Monate postoperativ klinisch nachkontrolliert. Resultate: Bei neun Patienten wurde eine Bursa olecrani entfernt, viermal eine Bursa präpatellaris. In 11 Fällen handelte es sich um eine akute, infizierte Bursitis. Die Eingriffe wurden je zur Hälfte in Vollnarkose bzw. Regionalanästhesie durchgeführt. Intra- sowie postoperative Komplikationen wurden keine beobachtet. Bei den Nachkontrollen waren sämtliche Patienten beschwerdefrei und zeigten eine volle Funktion des betroffenen Gelenks. Schlussfolgerung: In unseren Händen hat sich das endoskopische Bursashaving zur chirurgischen Therapie der Bursitis bewährt. Im Vergleich zur konventionellen Bursektomie können insbesondere Wundheilungsstörungen und chronische Narbenbeschwerden reduziert werden.

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