Cervical esophageal capillary hemangioma removed by combined and sequential endoscopic ligation and snare polypectomy.

rare benign esophageal tumor, and is usually asymptomatic [1]. More and more patients with esophageal heman− gioma are being treated endoscopically [2 ±3] by combined techniques in order to prevent massive bleeding, although the advantages are still controversial. A 68−year−old Chinese male, complaining of intermittent pharyngeal obstruction, was found to have a round, smooth pro− truding lesion with almost normal esoph− ageal mucosa (19 cm from the incisors) by routine esophagogastroduodenoscopy (Olympus XQ240, Japan) (l" Fig. 1). Con− trast−enhanced computed tomography (CT) showed an irregular intramural mass lesion in the cervical esophagus, 0.7 ” 0.6 cm in size. There was marked en− hancement following intravenous con− trast (CT value = 184.61 Hu), and high density on delayed scan (CT value = 98.9 Hu) (l" Fig. 2). In order to prevent mas− sive bleeding, we decided to perform combined and sequential endoscopic li− gation and snare polypectomy, in order to remove the lesion endoscopically. The patient signed the informed consent form. In brief, the tumor was aspirated into a hood cap attached to the top of the endo− scope and ligated with an O−ring in a manner similar to that used for endo− scopic variceal ligation (Saeed ligator, Wilson−Cook Medical GI Endoscopy, USA) (l" Fig. 3 a). One week later, the tu− mor was not so fragile and was removed by snare polypectomy (l" Fig. 3 b). No bleeding occurred and the base of the cut− ting was clear. After removal of the lesion, the symptoms disappeared. Pathology showed lobulated capillary hemangioma with ulceration (l" Fig. 4) and strong po− sitive CD34 staining (l" Fig. 5). No re− markable thrombosis and necrosis were found pathologically. No recurrence was evident after 2 months. We did notice that prior ligation can facilitate the proce− dure of snare polypectomy, which is the advantage of the combined technique over the simple snare polypectomy. In conclusion, combined and sequential ligation and snare polypectomy is a good option for the endoscopic removal of esophageal protruding hemangioma. But the efficacy and advantages of prior liga− tion still need more investigation.