Inflammatory Esophageal Pseudopolyp

The image shows a single filling defect in the distal esophagus that arises at the gastric cardia in a patient with known gastroesophageal reflux. This is the typical appearance of an inflammatory pseudopolyp, a thickened fold of gastric mucosa without malignant potential.

"Demonstration of a prominent straight gastric fold terminating in a smooth polypoid expansion near the squamocolumnar junction in a patient with reflux is characteristic of a benign inflammatory pseudopolyp, making endoscopy or biopsy unnecessary." If the appearance is not typical for a benign inflammatory pseudopolyp, the following may be considered:

• Adenomatous polyp: Arising from adenomatous tissue in the distal esophagus, usually within Barrett esophagus. Malignant degeneration is possible, especially in larger polyps, so endoscopic removal is recommended.
• Varices:
• Esophageal papilloma: Fibrovascular excrescences covered with squamous epithelium. No malignant potential, but usually removed endoscopically
• Leiomyomas:
• Foreign body: Food usually lodges above the esophagogastric junction. Glucagon can be administered to decrease pressure of the lower esophageal sphincter and allow passage of the bolus. More invasive measures can also be taken (e.g., endoscopic retrieval), Persistent impaction can lead to transmural ischemia and perforation. Once the bolus has passed or been removed, workup should be directed at excluding pathology (e.g., cancer) causing stricture.
• Cancer:

References

Styles RA, Gibb SP, Tarshis A, Silverman ML, Scholz FJ. Esophagogastric polyps: radiographic and endoscopic findings. Radiology. 1985 Feb;154(2):307-11.