Clin Endosc.  2019 Mar;52(2):186-190. 10.5946/ce.2018.083.

First Characterization with Ultrasound Contrast Agent of a Fibrovascular Polyp Before Its Endoscopic Resection: A Case Report (with Videos)

• Williet N
• Kassir R
• Casteillo
• Yvorel V
• Habougit C
• Roblin X
• Phelip JM

• KMID: 2447677
• DOI: http://doi.org/10.5946/ce.2018.083

Abstract

We described for the first time the contrast enhancement of a giant fibrovascular esophageal polyp using ultrasound contrast agent, Sonovue® (Bracco, Milan, Italy) during echoendoscopy. Fine Doppler was unsuccessful in showing vascularization due to the mobile characteristic of the tumor. In contrast, via Sonovue®, tissue microcirculation was highlighted inside the entire head of the polyp, leading to better appreciate the risk of bleeding related to its resection. In a second part, we showed the feasibility of classic polypectomy for this giant polyp (5×5 cm) without complication and results of control endoscopy at 3 months. The present case is summarized in a video.

Keyword

Esophageal fibrovascular polyp; Ultrasound endoscopy contrast enhancement; Polypectomy; Microvascularization

MeSH Terms

Endoscopy
Head
Hemorrhage
Microcirculation
Polyps*
Ultrasonography*

Figure

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  Fig. 1. Positron emission tomography scanning incidentally showing a non-local glucose metabolic esophageal tumor extended from the cervical esophageal— mouth to the lower esophageal area.

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  Fig. 2. (A) Endoscopic view of the esophageal fibrovascular polyp. Long thin peduncle (P) and the head (H) of the polyp; (B) Ultrasound endoscopy imaging of the head (H) of the polyp; (C) Idem B with Fine doppler; (D) Contrast-enhanced endoscopic ultrasound of the head (H) of the polyp at the same plane of the aorta (Ao), with low mechanical index (MI).

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  Fig. 3. Steps of fibrovascular polyp resection. (A) Applying a large clip; (B) adrenaline injection; (C) polyp catching with a 30-mm snare; (D) Peduncle coagulation by snare before cutting.

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  Fig. 4. (A) Upper: gross external aspect (square=1 cm), Lower: cut surface showing homogeneous yellowish color. (B) Low magnification view showing a central fibrous and adipose core surrounded by squamous epithelium, hematoxylin and eosin (H&E), ×1. (C) Squamous epithelium covering the entire surface with dilated vessels below the epithelium, H&E, ×100 (inlay, H&E, ×200). (D) Degenerative atypias of adipocytes, H&E, ×400.

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