Esophageal capillary hemangioma is a rare benign esophageal tumor, and is usually
asymptomatic [1]. More and more patients with esophageal hemangioma are being treated endoscopically
[2]
[3] by combined techniques in order to prevent massive bleeding, although the advantages
are still controversial.
A 68-year-old Chinese male, complaining of intermittent pharyngeal obstruction, was
found to have a round, smooth protruding lesion with almost normal esophageal mucosa
(19 cm from the incisors) by routine esophagogastroduodenoscopy (Olympus XQ240, Japan)
([Fig. 1]). Contrast-enhanced computed tomography (CT) showed an irregular intramural mass
lesion in the cervical esophagus, 0.7 × 0.6 cm in size. There was marked enhancement
following intravenous contrast (CT value = 184.61 Hu), and high density on delayed
scan (CT value = 98.9 Hu) ([Fig. 2]). In order to prevent massive bleeding, we decided to perform combined and sequential
endoscopic ligation and snare polypectomy, in order to remove the lesion endoscopically.
The patient signed the informed consent form.
Fig. 1 Endoscopy revealed a round, smooth protruding lesion covered by an almost normal esophageal
mucosa at 19 cm apart from the incisor.
Fig. 2 Contrast-enhanced computed tomography (CT) showed an intramural mass lesion in the
cervical esophagus, 0.7 × 0.6 cm in size, with marked enhancement following intravenous
contrast (CT value = 184.61 Hu) and high density on delayed scan (CT value = 98.9
Hu).
In brief, the tumor was aspirated into a hood cap attached to the top of the endoscope
and ligated with an O-ring in a manner similar to that used for endoscopic variceal
ligation (Saeed ligator, Wilson-Cook Medical GI Endoscopy, USA) ([Fig. 3 ]
a). One week later, the tumor was not so fragile and was removed by snare polypectomy
([Fig. 3 ]
b). No bleeding occurred and the base of the cutting was clear. After removal of the
lesion, the symptoms disappeared. Pathology showed lobulated capillary hemangioma
with ulceration ([Fig. 4]) and strong positive CD34 staining ([Fig. 5]). No remarkable thrombosis and necrosis were found pathologically. No recurrence
was evident after 2 months. We did notice that prior ligation can facilitate the procedure
of snare polypectomy, which is the advantage of the combined technique over the simple
snare polypectomy.
Fig. 3 a The lesion appearance 1 week after ligation and before polypectomy; b The mucosal appearance after snare polypectomy.
Fig. 4 The pathological examination showed lobulated capillary hemangioma (hematoxylin &
eosin, × 200).
Fig. 5 The immunohistochemical test showed strong positive staining for CD34 (× 200).
In conclusion, combined and sequential ligation and snare polypectomy is a good option
for the endoscopic removal of esophageal protruding hemangioma. But the efficacy and
advantages of prior ligation still need more investigation.
Endoscopy_UCTN_Code_TTT_1AO_2AG
