St. Louis University School of Medicine St. Louis, MO, United States
Aditya Suresh, MD1, Samuel Burton, MD2, Jason Taylor, MD2, Alex Befeler, MD2 1St. Louis University School of Medicine, St. Louis, MO; 2St. Louis University, St. Louis, MO
Introduction: Fibrovascular polyps are rare benign intraluminal submucosal pedunculated tumors composed of fibroadipose tissue. As polyps grow & encompass more intraluminal pass, patient will present with symptoms of dysphagia or chest pain. In this case, we describe a patient with a giant fibrovascular, esophageal polyp that was found incidentally on esophagogastroduodenoscopy for management of variceal hemorrhage.
Case Description/Methods: A 58-year-old male with newly diagnosed Hepatitis C cirrhosis, decompensated by ascites, presented with one episode of hematemesis. He reported no recent NSAID or alcohol use. He was hemodynamically stable with blood pressure 110/60 & heart rate 90 bpm. Physical exam was remarkable for distended abdomen with positive fluid wave. Labs were notable for hemoglobin 9.5, platelets 86, INR 1.5, & total bilirubin 1.8. Patient was initiated on octreotide, proton pump inhibitor, & ceftriaxone. Urgent EGD was performed. A large intraluminal lesion was seen in proximal esophagus. With the base of the lesion at 20cm from the incisors, the rest of the lesion protruded entirely intraluminal to 30cm from incisors with a normal appearing mucosal surface. With no signs of active bleeding from the lesion, the endoscopy continued with examination of the rest of esophagus. Four columns of Grade III esophageal varices were found with stigmata of recent bleed including a fibrin plug. Six bands were placed with incomplete eradication. Due to patient’s variceal bleeding & severity of liver disease, resection of the suspected fibrovascular polyp until was deferred until liver disease was more stabilized.
Discussion: Fibrovascular polyps are rare submucosal intraluminal tumors of esophagus, typically originating from the cervical esophagus. They are benign tumors but primarily cause morbidity in the form of dysphagia & substernal discomfort. However, they can be life threatening with reported cases of asphyxiation from these enlarging polyps.
In this case we see an asymptomatic patient with an incidentally found, suspected, fibrovascular polyp. While the patient did complain of some nausea, this was primarily after the onset of hematemesis & not a chronic progressive process as would be expected if solely due to polyps. Treatment is primarily achieved through resection. Due to the risks of intervention in a patient with decompensated cirrhosis, it is our opinion that the risks of intervention to resect an asymptomatic & generally benign fibrovascular polyp in this patient outweighed the benefits.
Figure: Suspected Giant Fibrovascular Polyp
Aditya Suresh indicated no relevant financial relationships.
Samuel Burton indicated no relevant financial relationships.
Jason Taylor indicated no relevant financial relationships.
Alex Befeler indicated no relevant financial relationships.
Aditya Suresh, MD1, Samuel Burton, MD2, Jason Taylor, MD2, Alex Befeler, MD2. P2432 - There Is Something in the Esophagus: Incidentally Found Fibrovascular Polyp During Variceal Hemorrhage, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.