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Ahmad AI, Lee A, Nithagon P, Ayaz O, Altork N, Peppas S, Alzraikat S, Ayoubi R, Smith A, Dhanjal R, Jassal A, Rizzo SM, Cho WK. Esophageal squamous papilloma: Literature review and case-control retrospective study with histopathological exam of human papillomavirus. JGH Open 2023; 7:674-681. [PMID: 37908288 PMCID: PMC10615170 DOI: 10.1002/jgh3.12942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/29/2023] [Indexed: 11/02/2023]
Abstract
Background and Aim Esophageal squamous papilloma (ESP) is a benign growth in the esophagus with unknown malignant potential. The mechanism underlying ESP formation is unknown, but human papillomavirus (HPV) infection has been proposed as a potential etiology. We sought to investigate the clinical characteristic of ESP in our population, review the current literature, and highlight the role of HPV. Methods This is a retrospective case-control study conducted at two referral centers. We selected the ESP population by free-text search in the pathology department database and selected controls randomly from the general endoscopy population. Immunostains were used to evaluate ESP tissue for HPV. Results Between January 2016 and December 2021, we identified 66 patients with ESP, with a prevalence of 0.72%. ESP patients were younger, with a median age of 52 years (P = 0.021), and more likely African American (34.4 vs 7.5%, P < 0.001) compared to controls. On endoscopy images, the growth was predominantly solitary (92.5%) in the middle of the esophagus (39.4%), with sizes ranging from 0.2 to 2.3 cm. A total of 62 patients had available tissue for HPV immune staining, and none tested positive for HPV. Eighteen patients had a follow-up endoscopy with an average of 504.5 days follow-up period. One patient developed esophageal squamous cell carcinoma during follow-up. Conclusions We observed a higher prevalence of ESP compared to previous studies. The formation of ESP is multifactorial and partially explained by HPV infection in selected populations. The malignant potential of ESP is low but not negligible.
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Affiliation(s)
- Akram I Ahmad
- Department of Internal MedicineMedStar Washington Hospital CenterWashingtonDCUSA
| | - Arielle Lee
- Department of MedicineGeorgetown University School of MedicineWashingtonDCUSA
| | - Pichayut Nithagon
- Department of PathologyGeorgetown University School of MedicineWashingtonDCUSA
| | - Omair Ayaz
- Department of Internal MedicineMedStar Washington Hospital CenterWashingtonDCUSA
| | - Nadera Altork
- Department of Internal MedicineMedStar Washington Hospital CenterWashingtonDCUSA
| | - Spyros Peppas
- Department of Internal MedicineMedStar Washington Hospital CenterWashingtonDCUSA
| | - Sayel Alzraikat
- Department of Internal MedicineMedStar Washington Hospital CenterWashingtonDCUSA
| | - Reza Ayoubi
- Department of MedicineGeorgetown University School of MedicineWashingtonDCUSA
| | - Andrew Smith
- Department of MedicineGeorgetown University School of MedicineWashingtonDCUSA
| | - Rachna Dhanjal
- Department of MedicineGeorgetown University School of MedicineWashingtonDCUSA
| | - Ajay Jassal
- Department of MedicineGeorgetown University School of MedicineWashingtonDCUSA
| | - Samantha M Rizzo
- Department of MedicineGeorgetown University School of MedicineWashingtonDCUSA
| | - Won Kyoo Cho
- Department of MedicineGeorgetown University School of MedicineWashingtonDCUSA
- Department of Gastroenterology and HepatologyINOVA Medical SystemLeesburgVirginiaUSA
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Li D, Li C, Yan Y, Liu M. Esophageal papillomatosis: an exceedingly rare disease. Orphanet J Rare Dis 2023; 18:99. [PMID: 37120568 PMCID: PMC10149006 DOI: 10.1186/s13023-023-02703-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/20/2023] [Indexed: 05/01/2023] Open
Abstract
If esophageal papilloma (EP) is a rare condition, esophageal papillomatosis (EPS) is a distinct rarity. To date, only 53 well documented cases have been described in English literature. However, the number of reports on EPS significantly increased to over 40 cases during the past 20 years. Perhaps, this is due to the broad use of endoscopy and related research achievements. Most of the cases are individual and it seems that there are no associations between them. And up to now no guidelines can be followed. To further understand this exceedingly rare disease, we had a comprehensive review of the epidemiology, etiology, clinical manifestations, pathogenesis, treatment, and clinical course of EPS.
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Affiliation(s)
- Dandan Li
- Department of Gastrointestinal Medicine (Endoscopy Center), Jilin University, China-Japan Union Hospital, 126 Xiantai Street, Erdao, Changchun, 130033, People's Republic of China.
| | - Changfeng Li
- Department of Gastrointestinal Medicine (Endoscopy Center), Jilin University, China-Japan Union Hospital, 126 Xiantai Street, Erdao, Changchun, 130033, People's Republic of China
| | - Yuxing Yan
- Department of Gastrointestinal Medicine (Endoscopy Center), Jilin University, China-Japan Union Hospital, 126 Xiantai Street, Erdao, Changchun, 130033, People's Republic of China
| | - Minya Liu
- Department of Gastrointestinal Medicine (Endoscopy Center), Jilin University, China-Japan Union Hospital, 126 Xiantai Street, Erdao, Changchun, 130033, People's Republic of China
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Bi YH, Ren JZ, Li JD, Han XW. Fluoroscopic removal of fractured, retained, embedded Z self-expanding metal stent using a guidewire lasso technique: A case report. World J Clin Cases 2022; 10:2516-2521. [PMID: 35434073 PMCID: PMC8968587 DOI: 10.12998/wjcc.v10.i8.2516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 11/25/2021] [Accepted: 01/29/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There are few reports of a fractured esophageal self-expanding metallic stent (SEMS) and the lasso retrieval technique, forming a guidewire loop by directing the guidewire back up the external stent for retrieval. CASE SUMMARY A 74-year-old man complained of dysphagia approximately 6 mo after radical resection of esophageal cancer. Benign anastomotic stenosis was diagnosed, and a 20 mm in diameter and 60 mm in length esophageal covered SEMS was inserted after repeated balloon dilatation. About 13.5 mo after stenting, dysphagia recurred and esophagography showed severe stenosis above the proximal stent and stent removal was performed. One-third of the stent was removed and the fractured stent remained in the proximal esophagus. A suction tube was introduced through the guidewire and then the guidewire was grabbed, acting like a "lasso" on tightening. The remaining fractured stent was successfully removed by slowly pulling back the guidewire, with no fragments of stent wires retained. CONCLUSION The guidewire lasso technique is a simple, effective method of removing esophageal SEMS in rare cases of stent fracture.
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Affiliation(s)
- Yong-Hua Bi
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Jian-Zhuang Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Jin-Dong Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Xin-Wei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
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d’Huart MC, Chevaux JB, Bressenot AM, Froment N, Vuitton L, Degano SV, Latarche C, Bigard MA, Courrier A, Hudziak H, Koch S, Kull E, Peyrin-Biroulet L. Prevalence of esophageal squamous papilloma (ESP) and associated cancer in northeastern France. Endosc Int Open 2015; 3:E101-6. [PMID: 26135647 PMCID: PMC4477031 DOI: 10.1055/s-0034-1390976] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 09/26/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Esophageal squamous papilloma (ESP) is a rare lesion. The aims of this study were to assess the prevalence of ESP in northeastern France and the risk of associated squamous cell carcinoma (SCC). PATIENTS AND METHODS The charts of 78 patients who were diagnosed with ESP between January 2005 and February 2013 at three hospitals in northeastern France were reviewed. RESULTS A total of 55 305 endoscopies were performed and 78 ESP were diagnosed (0.01 %). Patients with ESP included 44 males (56.4 %), 34 females (43.6 %); median age 50, interquartile range (IQR) 19 - 86. Median follow-up was 21 months (IQR 0 - 91 mo) and median time between first and second endoscopy was 7 months (IQR 0.5 - 74 mo). Of the total number of patients, 35 (44.9 %) had a second endoscopy. Main endoscopy indication was dyspepsia (24.4 %). Most ESP were isolated (93.6 %) and located at distal esophagus (27 cm, IQR 16 - 40 cm). Median size was 3 mm (IQR 1 - 20 mm). ESP-associated endoscopic lesions were hiatal hernia in 12 patients and esophagitis in 11 patients. Endoscopic treatment was mainly excisional biopsies (60.3 %). Human papillomavirus (HPV) was not detected in the 6 patients with available data. Low dysplasia was found in 2 ESP. During follow-up endoscopies, 2 SCC were detected in 2 different patients; the first SCC was located at the previous resection site of the ESP and the second had a different location. Prevalence of associated cancer was 1.3 %. CONCLUSION Prevalence of ESP in northeastern France is similar to that previously reported. Endoscopic findings were also broadly the same as in previous reports. The occurrence of dysplasia and SCC should strongly encourage the endoscopist to totally remove the ESP and to start an endoscopic surveillance, given the potential risk of malignant transformation.
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Affiliation(s)
- Marie-Caroline d’Huart
- Inserm U954 and Department of Hepatogastroenterology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Jean Baptiste Chevaux
- Inserm U954 and Department of Hepatogastroenterology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | | | | | - Lucine Vuitton
- Department of Hepatogastroenterology, Besançon University Hospital, Besançon, France
| | | | - Clotide Latarche
- Inserm CIC-EC CIE6, Vandoeuvre-lès-Nancy, France and Department of Epidemiology and Clinical Evaluation, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Marc André Bigard
- Inserm U954 and Department of Hepatogastroenterology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Alain Courrier
- Department of Hepatogastroenterology, Metz Mercy Hospital, Metz, France
| | - Hervé Hudziak
- Inserm U954 and Department of Hepatogastroenterology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Stéphane Koch
- Department of Hepatogastroenterology, Besançon University Hospital, Besançon, France
| | - Eric Kull
- Department of Hepatogastroenterology, Metz Mercy Hospital, Metz, France
| | - Laurent Peyrin-Biroulet
- Inserm U954 and Department of Hepatogastroenterology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France,Corresponding author Laurent Peyrin-Biroulet, MD, PhD Inserm U954 and Department of HepatogastroenterologyNancy University HospitalAllée du Morvan54511 Vandoeuvre-lès-NancyFrance
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Seif SM, Altonbary AY, Elkashef WF. Esophageal squamous papilloma. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2015. [DOI: 10.4103/1110-7782.155858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Tanimu S, Rafiullah, Resnick J, Onitilo AA. Oesophageal papillomatosis, not amenable to endoscopic therapies, treated with oesophagectomy. BMJ Case Rep 2014; 2014:bcr-2013-200195. [PMID: 24789149 DOI: 10.1136/bcr-2013-200195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Oesophageal papillomatosis is a very rare entity, with only 10 cases (including ours) reported in the literature. We report a 51-year-old man with a 25-year history of dysphagia with solids and liquids who failed a trial of proton pump inhibitors and fluticasone. His initial endoscopy revealed a viliform mass with dense eosinophilic infiltrate without neoplasia. Endoscopic ultrasound examination revealed a 4×1.6×0.7 cm mucosal hemicircumferential lesion without regional adenopathy. Pathological findings from the oesophagectomy specimen confirmed oesophageal papillomatosis with no malignancy. Surveillance endoscopy 4 months later revealed the lesion had increased in size. Additional ablative therapies failed, and the patient underwent oesophagectomy. Surveillance CT of the chest and abdomen at 3 months and oesophagogastroduodenoscopy at 6 months were negative. This case illustrates that oesophageal squamous papillomatosis not amenable to medical therapy requires surgical treatment.
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Affiliation(s)
- Sabo Tanimu
- Department of Gastroenterology, Marshfield Clinic, Weston, Wisconsin, USA
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Abstract
Esophageal squamous papillomatosis is rare and has been associated with gastroesophageal reflux and recurrent respiratory papillomatosis. We report a case of extensive esophageal papillomatosis, no airway involvement and a slowly progressive clinical course with progressive strictures and ultimately fatal squamous cell carcinoma. In-situ hybridization performed on biopsy specimens was negative for high-risk human papilloma virus types. Due to the paucity of reported cases, little is conclusively known about the etiology, natural course and best clinical management of this disease. Human papilloma virus has been linked to some, but not all, cases, and the clinical course has been reported to vary from spontaneous regression to malignant transformation. Surveillance for malignancy by conventional endoscopic biopsies or computed tomography scan appears to have low sensitivity. This case illustrates the difficulties in clinical management and establishing a definite etiology in esophageal squamous papillomatosis.
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Affiliation(s)
- Patricia C Kao
- Department of Internal Medicine, University of Vermont College of Medicine, Burlington, 05405, USA
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Cheng YS, Li MH, Chen WX, Chen NW, Zhuang QX, Shang KZ. Complications of stent placement for benign stricture of gastrointestinal tract. World J Gastroenterol 2004; 10:284-6. [PMID: 14716840 PMCID: PMC4717021 DOI: 10.3748/wjg.v10.i2.284] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To observe the frequent complications of stent placement for stricture of the gastrointestinal tract and to find proper treatment.
METHODS: A total number of 140 stents were inserted in 138 patients with benign stricture of the gastrointestinal tract. The procedure was completed under fluoroscopy in all of the patients.
RESULTS: Stents were successfully placed in all the 138 patients. Pains occurred in 23 patients (16.7%), slight or dull pains were found in 21 patients and severe chest pain in 2 respectively. For the former type of pain, the patients received only analgesia or even no treatment, while peridural anesthesics was conducted for the latter condition. Reflux occurred in 16 of these patients (11.6%) after stent placement. It was managed by common antireflux procedures. Gastrointestinal bleeding occurred in 13 patients (9.4%), and was treated by hemostat. Restenosis of the gastrointestinal tract occurred in 8 patients (5.8%), and was apparently associated with hyperplasia of granulation tissue. In 2 patients, the second stent was placed under X-ray guidance. The granulation tissue was removed by cauterization through hot-node therapy under gastroscope guidance in 3 patients, and surgical reconstruction was performed in another 3 patients. Stent migration occurred in 5 patients (3.6%), and were extracted with the aid of a gastroscope. Food-bolus obstruction was encountered in 2 patients (1.4%) and was treated by endoscope removal. No perforation occurred in all patients.
CONCLUSION: Frequent complications after stent placement for benign stricture of the gastrointestinal tract include pain, reflux, bleeding, restenosis, stent migration and food-bolus obstruction. They can be treated by drugs, the second stent placement or gastroscopic procedures depend on the specific condition.
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Affiliation(s)
- Ying-Sheng Cheng
- Department of Radiology, Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, China.
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Mosca S, Manes G, Monaco R, Bellomo PF, Bottino V, Balzano A. Squamous papilloma of the esophagus: long-term follow up. J Gastroenterol Hepatol 2001; 16:857-61. [PMID: 11555097 DOI: 10.1046/j.1440-1746.2001.02531.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Squamous papilloma of the esophagus is a rare benign tumor; less than 200 cases have been reported in the literature. The prevalence of endoscopically diagnosed squamous papilloma of the esophagus has been reported in only a very few series, and varies from 0.01 to 0.43%. Clinical relevance and possible association with other pathological conditions, namely if it is a premalignant lesion, remain a matter of debate. The etiology is controversial, although a role of human papilloma virus has been recently proposed. The aim of this study was to try to determine the prevalence, clinical relevance, possible association with other pathological conditions of the upper digestive tract, and possible etiological role of human papilloma virus on our series of squamous esophageal papillomas. METHODS Data from a total of 7618 upper gastrointestinal endoscopies consecutively performed in 4 years were obtained. A 4-year follow up was carried out. RESULTS Squamous esophageal papilloma was found in nine patients (0.01%). The mean size of polyps was 4 mm and the mean distance from the dental ridge was 25 cm. Only one patient had more than one polyp. Two patients had liver cirrhosis and three had peptic ulcer disease. All squamous esophageal papillomas were removed and tested for human papilloma virus with commercial available kits for in situ hybridization, but none was found positive. CONCLUSION Squamous papilloma of the esophagus is an uncommon disease that does not appear to predispose to esophageal cancer. No association was found with human papilloma virus.
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Affiliation(s)
- S Mosca
- Department of Gastroenterology, Endoscopic Unit, Antonio Cardarelli Hospital, Naples, Italy.
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Nelson DB. Expandable metal stents: physical properties and tissue responses. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2001. [DOI: 10.1053/tgie.2001.22152] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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