Endoscopic resection of a giant esophageal fibrovascular polyp.

A 66-year-old woman consulted because of dysphagia and occasional regurgitation of a lump of tissue during episodes of vomiting over the previous 9 months. A computed tomography (CT) scan showed a giant esophageal mass emerging in the upper esophagus. Evaluation by endoscopic ultrasound (EUS) showed that the masswas very hypoechoic, and it was suspected to be lipoma. An endoscopic procedure was performed with the patient intubated, using a largechannel gastroscope (Pentax, Japan) and CO2 insufflation. The endoscopy showed a polyp with a diameter of 5cm at its base and a length of 15cm (●" Fig.1a). The mucosal appearance was normal and its lower part was ulcerated. Resection was commenced with the submucosal injection of saline mixed with adrenaline (1:10000) at the base of the polyp. The polyp was gradually dissected step by step at its base, using first a triangle-tip electrosurgical knife (●" Fig.1b,c) then a hook knife (Olympus, Japan) (●" Fig.1d;●" Video 1) using the Endocut current. Hemostasis was achieved using Coagrasper forceps (Olympus). The polyp was then caught with a snare (●" Fig.1e) and extracted using an overtube (●" Fig.2). No complications such as bleeding or perforation occurred. Histological analysis confirmed the fibrovascular nature of the polyp, which had been completely resected. Even though fibrovascular polyps are rare, they may cause morbidity and mortality, which makes their resection mandatory [1,2]. In such situations, two types of