Published online Feb 21, 2016. doi: 10.3748/wjg.v22.i7.2349
Peer-review started: July 6, 2015
First decision: July 19, 2015
Revised: August 12, 2015
Accepted: November 19, 2015
Article in press: November 19, 2015
Published online: February 21, 2016
AIM: To better understand some of the superficial tiny lesions that are recognized as squamous papilloma of the esophagus (SPE) and receive a different pathological diagnosis.
METHODS: All consecutive patients with esophageal polypoid lesions detected by routine endoscopy at our Endoscopy Centre between October 2009 and June 2014 were retrospectively analysed. We enrolled patients with SPE or other superficial lesions to investigate four key endoscopic appearances (whitish color, exophytic growth, wart-like shape, and surface vessels) and used narrow band imaging (NBI) to distinguish their differences. These series endoscopic images of each patient were retrospectively reviewed by three experienced endoscopists with no prior access to the images. All lesion specimens obtained by forceps biopsy were fixed in formalin and processed for pathological examination. The following data were collected from patient medical records: gender, age, indications for esophagogastroduodenoscopy, and endoscopic characteristics including lesion location, number, color, size, surface morphology, surrounding mucosa, and surface vessels under NBI. Clinicopathological features were also compared.
RESULTS: During the study period, 41 esophageal polypoid lesions from 5698 endoscopic examinations were identified retrospectively. These included 24 patients with pathologically confirmed SPE, 11 patients with squamous hyperplasia, three patients with glycogenic acanthosis, two patients with ectopic sebaceous glands, and one patient with a xanthoma. In the χ2 test, exophytic growth (P = 0.003), a wart-like shape (P < 0.001), and crossing surface vessels under NBI (P = 0.001) were more frequently observed in SPE than in other lesion types. By contrast, there was no significant difference regarding the appearance of a whitish color between SPE and other lesion types (P = 0.872). The most sensitive characteristic was wart-like projections (81.3%) and the most specific was exophytic growth (87.5%). Promising positive predictive values of 84.2%, 80.8%, and 82.6% were noted for exophytic growth, wart-like projections, and surface vessel crossing on NBI, respectively.
CONCLUSION: The use of three key typical endoscopic appearances - exophytic growth, a wart-like shape, and vessel crossing on the lesion surface under NBI - has a promising positive predictive value of 88.2%. This diagnostic triad is useful for the endoscopic diagnosis of SPE.
Core tip: Esophageal superficial and flat lesions possess a wide spectrum of clinical and pathological features. Understanding the endoscopic features of these lesions is essential for their detection, differential diagnosis, and management. Squamous papilloma of the esophagus (SPE) is a rare benign esophageal lesion characterised by whitish and wart-like projections under conventional endoscopy. Overall, 88.2% of patients with polypoid lesions who presented all three typical endoscopic features (exophytic growth, a wart-like shape, and crossing surface vessels) were ultimately histologically confirmed as SPE. Our results may allow endoscopists to more confidently simply observe SPE that meets all endoscopic criteria.