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Minimally Invasive Management of Giant Esophageal Polyp – a Case Report

Samuil Marinov, Anton Tonev, Alexander Zlatarov, Mehmed Hadzhiveli, Georgi Ivanov, Boris Andonov, Georgi Valentinov, Nikola Kolev, Valentin Ignatov, Krasimir Ivanov

Abstract

Introduction: The benign tumors of the esophagus are rare disease. Their size has a great variation – from a few centimeters to taking up the whole length of the esophagus. Usually, they present with dysphagia, anemia and in some cases - aspiration or protrusion through the mouth. The polyps are mainly of fibroepithelial origin. Most of them are treated surgically with cervicotomy or esophagotomy.

Materials and Methods: We present a case of a 65-year-old male patient with a large 18x5 cm esophageal polyp with an origin from the upper esophagus after the hypopharynx. The preoperative computed tomography angiography excluded the presence of large vessels in the polyp stalk and that helped to establish the surgical strategy – injection of aethoxysklerol at the polyp base and resection with the help of laparoscopic vessel sealer and divider (LigaSure™). The transoral endoscopic approach was achieved using Weerda diverticuloscope.

Results: The polyp was resected successfully. The vessel sealer provided excellent hemostasis and no damage to the surrounding tissues. The only limitation of the transoral approach was due to the large size of the polyp, which had to be extracted via gastrotomy through a 5cm midline laparotomy incision. The postprocedural period was uneventful, liquid food intake was restored on the 2nd postprocedural day and solid food on the 3rd day. The patient was discharged on the fifth day. After one-year follow-up no recurrence was detected. Discussion: Various approaches have been described for the removal of large esophageal polyps, varying from transoral hybrid approach, cervical approach, thoracoscopic approach and even esophagectomy according to the experience of the institution. Due to the benign characteristics of the disease more minimally invasive approach is preferred and it should be offered to the patient.

Conclusion: Preoperative staging of the disease is essential to determine the operational approach that will be applied. The LigaSure device can provide safe hemostasis and facilitate the resection of the polyp stalk. The minimally invasive approach even in cases of large esophageal polyp is safe and feasible and the tumor can be easily extracted via small laparotomy and gastrotomy.


Keywords

benign tumor, esophageal polyp, endoscopic approach


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