A polyp is an abnormal growth of tissue projecting from the lining of a mucous membrane. In the esophagus, this growth occurs on the inner lining of the muscular tube connecting the throat to the stomach. While polyps are common in other parts of the digestive tract, they are relatively rare in the esophagus. These growths warrant medical attention because they can potentially cause complications or harbor precancerous cells.
What Esophageal Polyps Are
Esophageal polyps are lesions resulting from the proliferation of the mucosa, the innermost layer, and the submucosal tissue of the esophagus. They are typically classified as either epithelial, arising from the surface lining, or mesenchymal, originating from the tissues beneath the surface layer. When these discrete protrusions appear, they can represent a variety of different pathologies.
The majority of polyps found in the esophagus are benign and non-neoplastic. The two most common types of benign epithelial polyps are inflammatory polyps and squamous papillomas. Inflammatory polyps are characterized by an exaggerated tissue response to mucosal injury and are often found near the gastroesophageal junction (GEJ). Squamous papillomas are a benign type that grows outward in a finger-like pattern and are sometimes associated with human papillomavirus (HPV) infection.
The fibrovascular polyp is a mesenchymal growth notable for being larger and often occurring in the upper third of the esophagus. These polyps are composed of fibrous, fatty, and vascular tissue covered by a normal epithelial layer. Adenomatous polyps, which carry a higher risk of cancerous change, are far less common and usually arise in the context of Barrett’s esophagus, a precancerous condition.
Common Causes and Symptoms
Chronic irritation of the esophageal lining is the primary underlying cause leading to the formation of many esophageal polyps. This persistent irritation often stems from Gastroesophageal Reflux Disease (GERD), where stomach acid repeatedly washes back into the esophagus. The acidic contents damage the lining, and the resulting inflammation (esophagitis) triggers a regenerative response that can manifest as an inflammatory or hyperplastic polyp.
Hyperplastic polyps are characterized by hyperplastic epithelium and inflamed stroma, and they are frequently seen in the region of the gastroesophageal junction. Other sources of chronic irritation, such as certain medications, chronic vomiting, infections, or prior surgical sites, can also provoke this abnormal tissue growth.
Many esophageal polyps are asymptomatic and discovered incidentally during medical examinations, but larger growths can produce noticeable signs. The most common symptom is dysphagia (difficulty swallowing), or a sensation that food is getting stuck. Large polyps can physically obstruct the narrow esophageal passage. Patients may also experience chest pain or burning, often mistaken for heartburn, or a feeling of something lodged in the throat. If the polyp surface erodes, it can lead to bleeding, manifesting as blood in the vomit or stool, or causing iron-deficiency anemia due to chronic blood loss. Rarely, a large polyp with a stalk can prolapse into the throat, potentially causing airway obstruction.
How Polyps Are Found and Removed
The primary method for diagnosing an esophageal polyp is through an upper endoscopy, also called an esophagogastroduodenoscopy (EGD). During this procedure, a thin, flexible tube equipped with a light and camera is passed down the throat to visually inspect the lining of the esophagus, stomach, and the first part of the small intestine. This allows the physician to precisely locate the polyp, assess its size, and determine if it has a stalk.
The visual inspection is followed by a biopsy, where a small tissue sample is taken for laboratory analysis. This pathological evaluation is the only way to definitively classify the polyp type and determine whether it is benign, inflammatory, or contains precancerous cells, which guides the appropriate treatment plan.
For removal, the standard procedure is endoscopic polypectomy, a minimally invasive technique performed during the endoscopy. Small polyps can often be resected using a specialized clamp or biopsy forceps. For larger polyps, a wire loop called a snare is used to encircle the base of the growth. An electric current is passed through the wire to both cut the polyp and cauterize the tissue to prevent bleeding.
If a polyp is particularly large or flat, a more advanced technique called Endoscopic Mucosal Resection (EMR) may be employed. EMR involves injecting a solution beneath the polyp to lift the tissue away from the deeper layers of the esophageal wall, creating a protective cushion. This lifting allows the polyp to be safely removed in one piece using the snare, reducing the risk of damage to the underlying tissue and ensuring complete removal for accurate pathological staging.
Long-Term Outlook and Surveillance
The long-term outlook following the removal of an esophageal polyp is determined by the specific type of growth identified in the pathology report. The majority of polyps, particularly the inflammatory and hyperplastic types, are benign and do not carry a significant risk of becoming cancerous. Once these benign growths are removed, the prognosis is excellent, and the patient generally requires no further intervention.
If the polyp is classified as an adenoma or shows signs of dysplasia, a more rigorous surveillance protocol is required. Adenomatous polyps are considered precancerous lesions, and their presence indicates a higher risk of developing esophageal cancer. The risk of cancer is directly proportional to the degree of dysplasia found in the removed tissue.
Patients with a history of dysplastic polyps or an underlying condition like Barrett’s esophagus are placed on a schedule for follow-up surveillance endoscopies. Individuals with mild dysplasia may be recommended for repeat endoscopy every three years, while those with moderate dysplasia require closer monitoring due to a significantly higher risk. Regular surveillance monitors the area for recurrence or the development of new growths, ensuring that any potential malignant change is detected and treated early.