Esophageal polyps
Introduction
Introduction to esophageal polyps Esophageal polyps ranks second in benign esophageal tumors, which is second only to esophageal leiomyoma. The tumors of esophageal polyps are composed of a number of fibrous vascular tissues, adipose tissue, and a matrix from the esophageal mucosa and submucosal tissues. The surface is covered with a normal esophageal mucosa, which is prone to secondary ulceration and hemorrhage. The fibrous component of the tumor is either loose fibrous tissue or dense collagen fibrous tissue, so it is also called fibroangioma, fibrolipoma, mucinous fibroid, Or pedicled lipoma and other names, Bematz and other think that it is more appropriate to name the esophageal polyp as "fibrolipoma". But the clinic is still used to call it esophageal polyps. basic knowledge The proportion of illness: 0.15% Susceptible people: no special people Mode of infection: non-infectious Complications: hypertrophic osteoarthrosis
Cause
Esophageal polyps
Esophageal polyps occur in the mucosal or submucosal tissues of the cervical esophagus. The cause is still unclear. The lesions are mostly in the cervical esophagus close to the level of the tracheal cartilage or the pharyngeal muscle. Postlethwait and Lowe (1991) collected 59 from the literature. In the case of esophageal polyps, except for one case of polyps originating from the upper thoracic segment of the esophagus, 5 cases originating from the middle thoracic segment and 6 cases originating from the lower thoracic segment, the remaining 47 cases (80%) occurred in the cervical esophagus.
Esophageal polyps are usually single, and cases with two or more polyps in the esophageal cavity are extremely rare. Esophageal polyps are relatively long, and their length can reach 10 to 20 cm. Some patients with esophageal polyps can be taken from the neck. The lumen extends down to the cardia and even into the stomach cavity.
Esophageal polyps are endoluminal benign lesions, initially small or mucosal tumors less than 1 cm in diameter, which grow slowly. Later, during their growth, they are shaped or cast by the sequential contraction (peristalsis) of the esophageal muscles. The effect is mostly cylindrical or long strips, often with thin and long pedicles, so it can slide up and down in the esophageal lumen. The polyps of the polyps are at the level of the pharyngeal muscles. Sometimes, the patients are due to the gastroesophageal Backflow and vomiting polyps from the esophageal cavity to the lower pharynx, outside the mouth or outside the mouth, and then swallowing it into the esophageal cavity. If the polyp vomits to the throat and cannot be returned, it will cause the patient to suffocate. Or cause cerebral hypoxia, with the gradual development and enlargement of esophageal polyps, some patients with obvious expansion of the esophageal cavity, easily misdiagnosed as esophageal achalasia or sputum, but esophageal polyps will not cause obstruction of the esophageal lumen.
Under the microscope, a typical esophageal polyp consists of fibrous vascular tissue, the surface of which covers the squamous epithelium of the esophagus, and can be seen ulcers, erosion or erosion. The fibrous tissue in the polyps can be loose mucous fibers or dense collagen. Fiber; the adipose tissue components in it are sometimes rich, sometimes rare. If the fibrous tissue components in polyps are more, the pathological diagnosis should be diagnosed as fibroids; if the components of polyps are mainly adipose tissue, it should be diagnosed as fat. Tumors, some esophageal polyps were diagnosed as hamartomas, the main diagnosis was based on adenoids in polyps, and there were obvious eosinophil infiltration in individual esophageal polyps, so the diagnosis was eosinophilic granuloma, esophageal Polypoid malignant tumors are rare in clinical practice, and their main pathological feature is that squamous cell carcinoma can be found at the top of benign polyps.
Prevention
Esophageal polyps prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Esophageal polyp complications Complications, hypertrophic osteoarthropathy
1. Esophageal polyps can cause ulcer bleeding, block the esophageal cavity or malignant transformation. Individual patients' esophageal polyps can not be returned to the esophagus after vomiting into the mouth and suddenly block the throat, which can lead to suffocation and death.
2. Patients with individual esophageal polyps may have hypertrophic osteoarthrosis. After surgical removal of polyps, the symptoms of combined hypertrophic osteoarthrosis will resolve or resolve, and the pathogenesis is still unclear.
Symptom
Esophageal polyp symptoms Common symptoms Post-sternal pain Eating vomiting Pharyngeal foreign body sensation Black stool esophageal obstruction Dysphagia Esophageal obstruction Weight loss Weight loss Difficulty
Esophageal polyps grow slowly, the patient's clinical symptoms appear later, the main symptoms are dysphagia. According to reports in the literature, about 56% of patients with esophageal polyps have symptoms of dysphagia, and their severity is closely related to the degree of esophageal obstruction. Common symptoms include vomiting after eating, gastroesophageal reflux, weight loss or weight loss. Many patients also complain of post-sternal pain and discomfort. If the polyps are large, they can compress the trachea, cause cough, difficulty breathing, asthma and even suffocation, but repeated upper respiratory tract. Infected patients are rare. When the mass grows to a certain extent, the patient has symptoms of esophageal obstruction or most of the esophageal obstruction. The main symptoms are dysphagia, vomiting or reflux. Because the food stimulates polyps or polyps for a long time. There are often ulcers on the surface of polyps, causing hematemesis or melena. Some patients feel that there is a degree of pain in the upper abdomen. Individual patients have more severe chest pain, similar to angina.
The unique clinical symptom of esophageal polyps is that the patient may vomit polyps to the hypopharynx or the mouth due to paroxysmal cough or vomiting, or the polyps may appear in the mouth regularly. The patient feels a foreign body sensation in the pharynx or feels the pharynx (oral There are tumors. According to reports in the literature, about 40% of patients with esophageal polyps have this symptom. Many patients try to bite the mass that protrudes into the mouth. Some patients cannot vomit to the esophagus in the mouth due to their old age and tooth loss. The polyp bites off, and with the swallowing action, the patient can re-swallow the mass that protrudes into the oral cavity into the esophageal cavity. Some patients can push it with their fingers when they feel a mass in the oropharynx. In the esophageal cavity, because of the pedicled esophageal polyps, the cervical esophagus and the oral cavity can move back and forth. The above clinical manifestations are mostly transient, and there are many positive findings in clinical examinations. Doctors encounter this in clinical work. Patients should consider the possibility of esophageal polyps, timely check the corresponding, early diagnosis and treatment, and be highly alert to the risk of tracheal obstruction and asphyxia caused by esophageal polyps.
Examine
Esophageal polyp examination
There were no special changes to the routine blood test.
Esophageal barium meal angiography
This examination still has some difficulties in the diagnosis of esophageal polyps, sometimes it is easy to cause missed diagnosis or misdiagnosis. If the polyps are large, there is a long strip in the esophageal lumen during the esophageal barium meal examination, and the sausage-like or stick-like filling defect shadow. The surface is smooth, the lower edge is round, slightly lobulated, and the shadow (polyps) can move up and down in the esophageal lumen with swallowing action. The tincture has a shunt on both sides; sometimes the tincture can completely surround the polyp Therefore, in the process of esophageal barium meal examination, it is not easy to find the attachment of polyps on the esophageal wall (pedicle); the esophageal lumen has different degrees of expansion or obvious expansion, but the extent of esophageal dilatation is often uneven, the tube wall is smooth, Esophageal mucosal folds become flat or disappear, because polyps block the esophageal cavity and food debris in the esophageal lumen, and the esophageal lumen is dilated, sometimes the esophageal polyps are misdiagnosed as achalasia or stenosis, or even in the esophagus The tumor is misdiagnosed as an esophageal foreign body. Once the esophageal polyp is misdiagnosed as achalasia, it may have serious consequences.
2. Endoscopy
Fiber esophagoscopy is of great value in the diagnosis of esophageal polyps. This examination can generally confirm the diagnosis, and may find the part of the polyp pedicle, which is helpful for treatment. In some cases, it is difficult to find polyps during endoscopy. In the pedicle, the position of the esophageal polyp in the esophageal lumen is often parallel to the longitudinal axis of the esophagus. The surface is a normal esophageal mucosa. The pathological examination of the living tissue is performed on the surface of the polyp. It is also often reported as normal esophageal mucosa. Be careful not to delay diagnosis and treatment.
3. Other inspections
In some patients with large esophageal polyps, the X-ray chest is on the positive radiograph, and the signs of mediastinal shadow widening can be seen. The CT scan of the esophagus can show the contour, size and relationship with the esophageal wall of the esophageal polyp. The tissue density can be judged by its nature.
Diagnosis
Diagnosis and differentiation of esophageal polyps
The diagnosis of esophageal polyps is mainly based on X-ray angiography and esophagoscopy. The clinical course is long, the symptoms are mild, the systemic symptoms are few, and the nutritional status is good.
Esophageal polyps with esophageal dilatation should be differentiated from achalasia; some polypoid malignancies in the esophageal cavity, such as esophageal sarcoma, pseudosarcoma, esophageal squamous cell carcinoma, esophageal barium meal When examined and endoscopy, the general appearance of the polyp is similar to that of the esophageal benign polyps.
