Post written by Yuki Morita, MD, and Toshiyuki Yoshio, MD, PhD, from the Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
An unusual, long polyp was detected extending from the hypopharynx to the lower thoracic esophagus of a patient. Polypoid fibroadipose tumors should be resected because they are occasionally malignant and could cause sudden death from airway obstruction.
During EGD, the patient suddenly experienced a strong vomiting reflex, and a giant pedunculated tumor was disgorged from her mouth. Instead of returning it to the esophagus, we performed emergent endoscopic submucosal dissection (ESD) of the tumor without adverse events because of concern for the risk of airway obstruction.
We feel it is important to showcase this video to raise awareness that giant polyps may develop in the esophagus and hypopharynx and can be disgorged from the mouth, risking airway obstruction. In that case, we should consider endoscopic resection instead of returning the polyp to the esophagus.
ESD is an appropriate way of resecting polypoid fibroadipose tumors, preserving swallowing and speaking functions. If you encounter the unlikely event of a patient disgorging the tumor from the mouth, emergent ESD is recommended.
The resected specimen showed a single base with multiple branched heads that was not fully recognized during EGD. If we returned the polyp to the esophagus, it was quite possible that a branched head would have strayed into the airway, causing a respiratory issue. Hence, we realized again while watching the resected polyp, that we made the right decision.
A, A CT scan shows an intraluminal tumor at the esophagus with low density (red arrows) and no findings suggestive of metastasis. B, Positron emission tomography–CT shows a highly concentrated area (red arrows), predominantly in the lower esophagus, which is the ulcerated head of the polyp observed via EGD.
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