ハサミ型ナイフで内視鏡的切除した巨大食道fibrovascular polypの1例

Endoscopic Resection of a Giant Fibrovascular Esophageal Polyp by Use of a Scissor-type Knife

要旨●患者は70歳代，女性．意識消失を主訴に救急外来を受診し，その際，胸部CTにて食道腫瘤を指摘された．上部消化管内視鏡検査を施行したところ，頸部食道に基部を有する長径10cm弱の有茎性病変を認めた．病変の大部分は扁平上皮で覆われていたが，病変辺縁はうろこ状外観を呈した．診断的治療としてハサミ型ナイフを使用し，全身麻酔下にて内視鏡的切除を行った．ハサミ型ナイフを用いることで安定した視野が得られ，安全に一括切除を施行し得た．病理組織学的所見からfibrovascular polypと診断した．うろこ状外観は病変辺縁と食道内腔面との摩擦による“熱傷”と考えられ，食道fibrovascular polypに付随するまれな肉眼所見と考えられた．

　A woman in her 70s presented to the emergency department because of loss of consciousness. Her chest CT revealed a large intraluminal tumor arising from the proximal esophagus. Esophagogastroduodenoscopy revealed an approximately 10cm long intraluminal pedunculated polyp arising from the cervical esophagus with a scaly margin. We performed endoscopic resection with a scissor-shaped device under general anesthesia. We removed the polyp en bloc safely and effortlessly while maintaining a stable view using a single device. Histologic analysis identified it as a fibrovascular polyp. The scaly margin was considered to be a burn-like change caused by friction with the esophageal lumen and a rare macroscopic finding associated with giant esophageal fibrovascular polyp.