Giant esophageal fibrovascular polyp with use of Sengstaken-Blakemore tube during surgery: A case report

Abstract

BACKGROUND

Esophageal fibrovascular polyp (FVP) is a rare benign tumor-like lesion of the esophagus, accounting for approximately 1%-2% of all benign esophageal tumors. FVPs with a diameter exceeding 5 cm are defined as giant fibrovascular polyps (GFVPs), with only a limited number of cases reported globally and domestically.

CASE SUMMARY

We report a case of a GFVP (12 cm × 6 cm × 3 cm) arising from the right pyriform sinus and protruding into the esophageal lumen. The patient presented with a 10-year history of recurrent nausea and vomiting accompanied by a throat foreign body sensation, with symptom exacerbation in the preceding four months. Following multidisciplinary evaluation by the Department of Gastroenterology and Otorhinolaryngology, the lesion was successfully resected via transoral low-temperature plasma resection under suspension laryngoscopy. Intraoperatively, a Sengstaken-Blakemore tube was applied. Its esophageal balloon was inflated below the mass for mechanically occluding the esophageal lumen. On that basis, distal migration of the mass after pedicle transection can be prevented, and complete resection can be ensured. The tumor was entirely resected. To be specific, the intraoperative blood loss was amounted to only 5 mL. The patient was discharged on postoperative day 7, and laryngoscopy at two weeks showed satisfactory healing at the surgical site.

CONCLUSION

The use of Sengstaken-Blakemore tube to prevent prolapse during FVP resection offers a new treatment option for some patients.

Key Words: Esophageal fibrovascular polyp; Laryngoscope; Cold plasma; Sengstaken-Blakemore tube; Case report

Core Tip: Fibrovascular polyp (FVP) are rare benign tumor-like lesion of the esophagus. Complete surgical resection is the traditional treatment for FVP. Notably, with advances in technology, transoral resection of esophageal lesions (primarily involving laryngoscopy and gastrointestinal endoscopy) has become increasingly feasible. However, resection of long-pedunculated polyps presents a major technical challenge. Once the pedicle is severed, the mass may fall into the distal esophagus or stomach, making retrieval difficult and potentially necessitating additional surgical intervention. This study reports a novel method that uses a Sengstaken-Blakemore tube to prevent this complication. To the best of our knowledge, this method has not been previously reported.

INTRODUCTION

Esophageal fibrovascular polyp (FVP) is a rare benign tumor-like lesion of the esophagus; giant fibrovascular polyps (GFVPs) (diameter > 5 cm) may cause progressive dysphagia, weight loss, and even death from asphyxiation due to glottis obstruction by the mass during reflux. At least seven fatal cases have been reported in the literature to date. Once an FVP is diagnosed, it should, in principle, be resected as early as possible to relieve mass effects, prevent life-threatening complications such as asphyxia, clarify the pathological nature of the lesion, and exclude the risk of malignancy. In terms of treatment strategies, traditional open surgical procedures via cervical or thoracic approaches ensure a high complete resection rate and reliable hemostasis; however, they are highly invasive, require prolonged hospitalization, and are associated with a relatively high complication incidence. In contrast, resection via suspension laryngoscopy or digestive endoscopy is particularly suitable for FVPs with a slender pedicle and relatively poor blood supply. In this case, the tumor was completely resected through transoral low-temperature plasma resection under suspension laryngoscopy. Accordingly, the significant trauma associated with thoracotomy or cervical incisions was avoided, and precise hemostasis was achieved using the cryo-vaporization cutting mode of the plasma knife. The intraoperative application of a Sengstaken-Blakemore tube to prevent tumor prolapse provides a novel approach for resecting high esophageal lesions with a narrow base. Furthermore, by reviewing relevant cases in the literature, this study summarizes the clinical manifestations, diagnostic methods, surgical procedure selection, and key points for differential diagnosis of FVP. This study serves as a reference to improve clinicians’ comprehensive understanding of FVP and their diagnostic and therapeutic experience.

CASE PRESENTATION

Chief complaints

A 59-year-old female patient presented to the Department of Gastroenterology on April 8, 2026 with a history of recurrent nausea and vomiting accompanied by a throat foreign body sensation for 10 years, with exacerbation in the preceding 4 months.

History of present illness

The patient reported a movable lump sensation in the throat during vomiting, accompanied by occasional acid regurgitation, belching, and heartburn. Symptoms worsened at night, especially in the supine position and after meals. The patient occasionally coughed but denied dysphagia, hematemesis, melena, fever, or weight loss. After symptom onset, the patient underwent laryngoscopy at another hospital on an unspecified date, which showed no significant abnormalities. On January 18, 2026, ultrasonography at another hospital revealed bilateral thyroid nodules and a hypoechoic mass posterior to the trachea, suspected to be of esophageal origin. The patient had intermittently taken oral omeprazole without significant relief. The patient’s mental status, sleep, and appetite had remained fair, and there was no significant weight loss.

History of past illness

The patient had no significant past medical history and denied any history of allergies, smoking, alcohol consumption, or prior surgery.

Personal and family history

The patient had no significant medical history and no personal or family history of cancer.

Physical examination

The vital signs were as follows: Body temperature 37 °C, heart rate 59 beats per minute, respiratory rate 18 breaths per minute, ablood pressure 122/76 mmHg, and body mass index 23.8 kg/m². The patient presented with a marked foreign body sensation in the pharynx. Physical examination revealed the trachea to be midline, with no significant thyroid enlargement and no notable acute edema of the pharyngeal mucosa. The remainder of the physical examination was unremarkable.

Laboratory examinations

Biochemical tests indicated hyperlipidemia (total cholesterol 6.38 mmol/L); all other routine blood test results and tumor marker levels were within normal limits.

Imaging examinations

On April 9, 2026, gastroscopy revealed a massive mucosal protrusion that extended from the pyriform fossa to 26 cm from the incisors, with a smooth mucosal surface and pedicle located in the larynx (Figure 1A and B). On April 10, 2026, enhanced mediastinal computed tomography (CT) revealed marked dilatation of the mid-to-upper esophageal lumen, in which a long, strip-like, slightly hypodense lesion was identified. The lesion extended superiorly to the level of the thyroid gland and was connected to the larynx via a pedicle. No significant enhancement was observed after contrast administration, suggesting a benign lesion (Figure 1C).

Figure 1 Gastroscopic examination and contrast-enhanced computed tomography. A: The base of the pedicle: Gastroscopic examination revealed that the tumor pedicle was located at the esophageal inlet, with the tumor prolapsed into the esophagus precluding complete visualization. No obvious active bleeding was observed at the pedicle mucosa, and the surrounding mucosa appeared pale red; B: Main body of the tumor: Gastroscopic examination revealed that the main body of the tumor was round-to-oval in shape, protruding prominently into the esophageal lumen. The surface mucosa of the lesion was intact and smooth, with a pale red color. The vascular pattern of the surrounding esophageal mucosa was clearly visible, and the lumen showed a certain degree of narrowing; C: Contrast-enhanced computed tomography scan of the mediastinum demonstrated a tumor occupying the entire esophageal lumen, with marked esophageal dilatation. The lesion showed homogeneous soft-tissue density, well-defined margins, and no significant enhancement.

FINAL DIAGNOSIS

Routine hematoxylin and eosin (HE) staining was performed on the postoperative specimens. Microscopic examination demonstrated that the tumor surface was covered by stratified squamous epithelium, with significant thickening of the submucosal layer. The thickened submucosa comprised loose connective tissue, numerous thick-walled blood vessels, and fibrous tissue, accompanied by marked stromal edema and a mucinous appearance. No adipose tissue components were detected within the lesion, and no deeply stained atypical adipoblasts or atypical stromal cells were identified. Collectively, these morphological features were consistent with a diagnosis of GFVPs (Figure 2).

Figure 2 Histopathological examination. A: Histopathological examination (HE) staining revealed that the tumor surface was covered by stratified squamous epithelium, with marked thickening of the submucosa, which was composed of loose connective tissue, numerous thick-walled vessels, and fibrous tissue, accompanied by prominent stromal edema and myxoid changes (HE staining, objective ×4, scale bar = 1025 μm); B: HE staining revealed submucosal fibrovascular proliferation, with no hyperchromatic atypical lipoblasts or atypical stromal cells identified (HE staining, objective ×10, scale bar = 225 μm).

TREATMENT

On April 16, 2026, the patient underwent resection of the esophageal lesion under suspension laryngoscopy under general anesthesia. Following the induction of general anesthesia, orotracheal intubation was performed, and intermittent positive-pressure ventilation was administered. Oxygen saturation and end-tidal carbon dioxide partial pressure were continuously monitored throughout the procedure. Intraoperative suspension laryngoscopy demonstrated that the tumor pedicle was located on the inferolateral wall of the right piriform sinus and extended to the proximal cervical esophagus, with a pedicle area of approximately 1 cm². The tumor had prolapsed into the esophagus, which became difficult to fully visualize. A Sengstaken-Blakemore tube was first inserted and inflated for preventing the tumor from falling into the digestive tract after being freed. The specific steps are presented below: (1) After adequate lubrication, the tube was inserted orally, and its position in the esophagus (rather than the trachea) was confirmed by laryngoscopy; (2) Based on the preoperative gastroscopic measurement of 26 cm from the incisors to the distal end of the tumor, the tube was advanced to approximately 30 cm from the incisors to ensure that the entire balloon passed beyond the distal tumor margin and entered the stomach. Approximately 100 mL of air was slowly injected into the esophageal balloon; the inflation volume varied individually and was adjusted in real time according to balloon pressure. After balloon inflation, the entire tube was slowly withdrawn. Obvious resistance was felt when the upper edge of the balloon contacted the distal end of the tumor, at which point tube withdrawal was terminated. This step confirmed successful occlusion of the esophageal lumen by the balloon, and the tube was fixed at the mouth corner; (3) Balloon pressure was intermittently monitored via a cuff pressure manometer connected to the inflation port. The pressure was maintained at 30-45 mmHg to effectively occlude the lumen and prevent excessive distension and ischemia based on the safe threshold for balloon compression of esophageal varices. The actual intraoperative pressure ranged from 30 mmHg to 35 mmHg; and (4) The balloon was kept fully inflated to occlude the esophagus for 20 minutes from complete inflation until total resection and removal of the tumor. The balloon was deflated immediately after tumor resection, with no repeated inflation performed during the operation. After safe placement of the Sengstaken-Blakemore tube, the upper pole of the tumor was grasped with cup forceps, the tumor pedicle was dissected using a plasma knife, and wound bed hemostasis was achieved via electrocoagulation. The estimated intraoperative blood loss was approximately 5 mL. A smooth, white, soft tumor measuring 12 cm × 6 cm × 3 cm was completely excised (Figure 3). After tumor resection and complete balloon deflation and removal, the esophageal mucosa within the laryngoscopic visual field was carefully examined prior to laryngoscope withdrawal; no mucosal laceration, ecchymosis, or ischemic pallor was identified. Postoperatively, the patient did not develop retrosternal pain, subcutaneous emphysema, hematemesis, or melena, thereby suggesting delayed perforation or severe mucosal injury. Besides, vital signs remained stable. Postoperative management included nasogastric tube decompression (using a separately placed standard nasogastric tube; the Sengstaken-Blakemore tube used intraoperatively was removed immediately after tumor resection and was not retained postoperatively), administration of lansoprazole (30 mg intravenously once daily) for acid suppression and mucosal protection, and piperacillin-tazobactam (4.5 g intravenously three times daily) for infection prophylaxis, which was de-escalated to ceftriaxone sodium (2 g intravenously once daily) on postoperative day 3. In addition, budesonide (1 mg nebulized twice daily) was used for sputum reduction, and cetylpyridinium chloride mouthwash (10 mL gargle three times daily) was provided for oral care. All of the above medications were continued until discharge. On postoperative day 2, bowel sounds returned and flatus passed smoothly, allowing initiation of a liquid diet; on postoperative day 3, the diet was advanced to a semi-liquid diet, with concurrent antibiotic de-escalation as described above. On postoperative day 4, the nasogastric tube was clamped for 24 hours. Given the absence of abdominal distension, nausea, or any other adverse symptoms, the tube was removed. Following tube removal, the patient continued a semi-liquid diet, which was gradually transitioned to a soft diet.

Figure 3 Macroscopic appearance of the tumor: The resected gross specimen was crescent-shaped, with a cut surface showing a white-and-yellow mottled appearance. At one end, a surgical resection margin with mild hemorrhage was noted. The scale indicated that the maximum diameter of the specimen was approximately 12 cm.

OUTCOME AND FOLLOW-UP

The patient recovered uneventfully after surgery, without complications (e.g., fever, retrosternal pain, worsening dysphagia, hematemesis, and melena). On postoperative day 7 (April 9, 2026), the patient was in good general condition with satisfactory oral intake, was deemed fit for discharge, and was subsequently discharged. The patient returned for a follow-up outpatient visit 2 weeks after discharge (May 6, 2026). The patient reported that swallowing function had fully recovered, had resumed a normal diet, and had no symptoms of retrosternal discomfort or reflux. The patient’s ability to carry out daily activities and work had returned to preoperative levels. Laryngoscopy at that time showed chronic pharyngeal congestion, satisfactory healing at the surgical site, and no residual or recurrent lesions.

To clearly present the entire diagnostic and therapeutic course of this case, we have constructed a clinical timeline (Figure 4).

Figure 4 Clinical timeline of the patient: The timeline illustrates the clinical course from symptom onset in approximately 2016 to the follow-up laryngoscopy in May 2026. Blue circles indicate non-surgical clinical events; the red circle indicates the surgical intervention (endoscopic resection of the esophageal lesion under suspension laryngoscopy). The break in the time axis denotes a large interval between approximately 2016 and January 2026 and is not drawn to scale. CT: Computed tomography; CBC: Complete blood count; ECG: Electrocardiogram; US: Ultrasonography.

DISCUSSION

Esophageal FVPs are rare benign intraluminal tumor-like lesions of the esophagus, accounting for approximately 1%-2% of all benign esophageal tumors[1]. FVPs with a diameter greater than 5 cm are defined as GFVPs. To date, only a limited number of case reports regarding this disease have been published. Historically, this lesion has been described under various names, including fibromas, fibroepithelial polyps, pedunculated lipomas, fibrolipomas, and myxofibromas. However, the World Health Organization unified the nomenclature as “FVP” in 1990[2]. Esophageal FVPs arise from the submucosa of the cervical esophagus, characterized by a long pedicle and intraluminal growth, and may extend downward to the lower esophagus or even the stomach. The lesions most commonly originate from the Killian triangle above the cricopharyngeus muscle and the Laimer-Haeckermann triangle at the esophageal inlet. FVPs consist of loose submucosal tissue lacking sufficient structural support; repeated traction during swallowing gradually elongates and enlarges the mass[3]. Despite their benign pathological nature, giant polyps can induce severe dysphagia and weight loss, and may even cause fatal asphyxiation due to lesion regurgitation and glottic obstruction. At least seven fatal cases have been documented in the existing literature[4], which warrants close clinical attention.

FVPs grow slowly. Consequently, early diagnosis becomes challenging. Progressive dysphagia has been demonstrated as the most common symptom. In some patients, the polyp may regurgitate into the oral cavity during coughing or vomiting, presenting as a smooth, tongue-shaped mass protruding from the mouth, resembling a ‘snake tongue’, which can spontaneously reduce. This characteristic finding is highly suggestive of the diagnosis, but its incidence is low (approximately 12%)[5]. The present patient had a 10-year disease course, with symptoms predominantly consisting of nausea, vomiting, and a foreign body sensation in the throat, and an absence of progressive dysphagia and the characteristic ‘oral protrusion of the mass’, which resulted in a prolonged period without a definitive diagnosis. This highlights that clinicians should consider esophageal FVP in the differential diagnosis of chronic unexplained laryngopharyngeal symptoms, particularly when symptoms are associated with eating or postural changes. The diagnosis of FVP requires a combination of multiple diagnostic modalities, as a single examination carries a high rate of missed diagnoses. In this patient, laryngoscopy alone was performed prior to diagnosis but failed to detect the lesion. This was because the lesion arose from the right inferolateral wall of the pyriform sinus and extended to the cervical esophageal inlet – an atypical site of origin – and the mass had prolapsed into the esophagus, rendering it relatively concealed. Therefore, the combined use of various examinations is crucial for improving diagnostic accuracy. Currently, barium esophagography is recommended as the initial screening modality. If an intraluminal filling defect is identified, further gastroscopy combined with endoscopic ultrasonography should be performed to define the lesion extent, pedicle location and originating layer, supplemented by contrast-enhanced CT or magnetic resonance imaging to assess blood supply and facilitate surgical planning. In this case, an ultrasound scan performed at another hospital suggested a ‘hypoechoic mass posterior to the trachea’, raising suspicion of malignancy. However, combined evaluation via gastroscopy and contrast-enhanced CT confirmed the lesion to be a benign pedunculated mass, underscoring the necessity of a tiered, progressive multi-modality diagnostic approach.

Once FVPs have been diagnosed, resection should in principle be performed as early as possible. The goals of intervention are to relieve mass-related effects, prevent life-threatening complications such as asphyxiation, establish the pathological diagnosis, and exclude the risk of malignant transformation. Traditional open surgical approaches via the neck or thorax can achieve high resection rates and reliable hemostasis, yet they are associated with considerable surgical trauma and higher complication rates. At present, the main transoral approaches for resection of pedunculated esophageal polyps include snare electrocautery resection, endoscopic submucosal dissection, CO₂ laser resection under suspension laryngoscopy, and low-temperature plasma resection. One common technical pitfall of these procedures is that once the pedicle has been transected, the unanchored lesion may slip distally as a result of gravity or esophageal peristalsis. Preventive strategies reported in available literature mainly involve pre-placement of hemostatic clamps or nylon snares at the pedicle before transection, followed by resection[6]. This approach is suitable for lesions with a well-exposed, small-diameter pedicle. However, pre-ligation becomes substantially more difficult owing to the confined operating space when the pedicle lies within anatomically narrow sites, for example the pyriform sinus or esophageal inlet.

In this case, the FVP measured 12 cm in length, exceeding the conventional upper limit (5-8 cm) recommended in the existing literature[7] for resection via digestive endoscopy or suspension laryngoscopy. However, the lesion presented three favorable characteristics: A narrow base (approximately 1 cm²), poor vascularity (no enhancement on contrast-enhanced CT), and a pedicle position suitable for exposure via suspension laryngoscopy. Following joint evaluation by the Department of Gastroenterology and Otorhinolaryngology, we therefore performed low-temperature plasma resection under suspension laryngoscopy, using a Sengstaken-Blackmore tube during the procedure to prevent downward displacement of the mass. This device, introduced in the 1950s, comprises a gastric balloon, an esophageal balloon and a gastric aspiration port, and was originally developed for mechanical compression hemostasis of bleeding esophagogastric varices. Compared with the modified Minnesota tube (which features an esophageal aspiration port to lower aspiration risk) and the Linton-Nachlas tube (with a large-volume gastric balloon for gastric varices), the Sengstaken-Blakemore tube’s esophageal balloon is an independent inflatable unit, making it easier to manipulate and more suitable for establishing a barrier in this case. In this case, we utilized the spherical expansion formed within the esophageal lumen by the inflated esophageal balloon to create a physical barrier beneath the mass (Figure 5). The advantage of this approach is that it does not require precise localization of the distal end of the tumor, thereby reducing the technical difficulty of the procedure and broadening its anatomical applicability. The method can indicate a shift from “active capture” to “passive interception”. On that basis, the technical threshold can be lowered, and the likelihood of successful resection can be increased. Since this tube is traditionally used primarily for hemostasis in varices and carries potential risks such as perforation and mucosal ischemia, the inflation pressure must be strictly controlled. Currently, there are no recommended pressure standards for the S-B tube when used as a mechanical barrier; we therefore referred to the safety threshold for balloon compression in varices (30-45 mmHg). The pressure measured during the procedure fluctuated between 30 mmHg and 35 mmHg, and the tube was left in place for 20 minutes. It should be noted that this reference is an off-label application; the objectives of hemostasis for varices and mechanical occlusion differ (the former requires blocking blood flow, while the latter only requires preventing the sliding of solid structures), and the minimum effective pressure remains undetermined, which represents one of the main limitations of this method. Therefore, during surgery, the lowest possible pressure should be used while ensuring an effective occlusion. No signs of mucosal injury or perforation were observed postoperatively in this case, providing a reference for the application of this pressure range in this clinical scenario. We performed a systematic literature search of PubMed, Web of Science, and CNKI databases up to April 2026. The applied keywords are presented below: (“Sengstaken-Blakemore tube” OR “balloon tamponade”) AND (“esophageal polyp” OR “fibrovascular polyp” OR “esophageal tumor”) AND (“resection” OR “excision”). No restrictions were applied on language or publication year. No reports were identified concerning the use of the Sengstaken-Blakemore tube as an intraoperative mechanical barrier. We suggest that low-temperature plasma resection under suspension laryngoscopy may be considered for FVP cases in which the pedicle is located at the hypopharynx or the esophageal inlet, with preoperative imaging confirming a narrow base, no complete tumor incarceration, and adequate working space. For lesions with a pedicle situated in the mid to lower esophagus, beyond the operational reach of suspension laryngoscopy, endoscopic removal may be considered. This procedure obviated thoracotomy or a large cervical incision, thereby reducing surgical trauma while ensuring radical resection. Intraoperative blood loss was minimal, and postoperative recovery was rapid. The successful outcome of this case was attributable to close collaboration between the Department of Gastroenterology (responsible for precise preoperative localization and imaging evaluation) and the Department of Otorhinolaryngology (responsible for resection under suspension laryngoscopy). This highlights the pivotal role of the multidisciplinary team approach in the management of complex esophageal lesions.

Figure 5 Schematic diagram of the Sengstaken-Blakemore tube placement technique. The tube is inserted through the nasal cavity, advanced below the mass, and the esophageal balloon is inflated to occlude the esophagus. The tube is then gradually retracted until the balloon contacts the distal end of the mass.

The typical histopathological features of FVP include a surface covered by normal squamous epithelium, with underlying fibrous tissue, adipose tissue and blood vessels. Immunohistochemically, CD31, CD34 and vimentin are positive, whereas smooth muscle actin may exhibit weak positivity confined to the vascular walls; all other markers are generally negative. Clinically, the differential diagnoses include esophageal leiomyoma (with smooth muscle bundles arranged in a mat-like pattern), well-differentiated liposarcoma of the esophagus (with deeply stained atypical lipoblasts or atypical stromal cells), inflammatory fibroid polyp (with an “onion-skin” pattern of spiral strata in the stroma), gastrointestinal stromal tumor (with spindle-shaped or epithelioid cells arranged in bundles), esophageal carcinosarcoma (containing malignant epithelial and stromal components, with marked cellular atypia), inflammatory myofibroblastic tumor (proliferating spindle-shaped fibroblasts or myofibroblasts arranged in bundles or swirls), and esophageal schwannoma (with typical Antoni A and Antoni B zones under the microscope), among others[8]. Although recurrence and malignant transformation of FVP are rare, such events have been documented in the literature, with recurrence intervals ranging from 6 years to 20 years[9]. Graham et al[8] performed a molecular cytogenetic study on 13 cases of esophageal polypoid fibrolipomatous tumors and demonstrated that many lesions previously diagnosed as recurrent or malignant “FVPs” were confirmed to be well-differentiated liposarcomas following molecular testing. It is recommended that all specimens suspected of FVP undergo MDM2 testing. If pathological examination identifies hyperchromatic atypical lipoblasts with strong nuclear MDM2 positivity and/or CDK4 positivity, the diagnosis should be revised to well-differentiated liposarcoma, with fluorescence in situ hybridization recommended for confirmatory testing. Postoperative specimens from this case only underwent routine HE staining, which microscopically demonstrated loose submucosal connective tissue with extensive fibrous and vascular proliferation accompanied by stromal edema. Microscopic examination confirmed the absence of adipose tissue, hyperchromatic atypical lipoblasts, and atypical stromal cells, with morphological findings consistent with GFVPs, thereby excluding the majority of differential diagnoses. Nevertheless, it is important to acknowledge that pure HE staining is insufficient to completely rule out the rare fat-poor variant of well-differentiated liposarcoma, which represents a major limitation of the present study. We will subsequently perform MDM2 and CDK4 immunohistochemistry on the archived paraffin blocks to further rule out the possibility of a well-differentiated liposarcoma. Accurate pathological diagnosis directly governs the patient’s postoperative surveillance strategy. For patients with confirmed FVP, endoscopic surveillance is generally recommended at 1-2 year intervals for up to 10 years. By contrast, the identification of a liposarcomatous component on pathological examination necessitates intensified follow-up[10]. In this case, laryngoscopic re-examination at two weeks postoperatively revealed satisfactory healing of the surgical site. However, the current follow-up duration is insufficient to evaluate long-term recurrence risk, which represents a major limitation of this study. A long-term follow-up plan has been established for the patient, comprising endoscopic re-examination at six months, one year and annual intervals thereafter, to acquire reliable long-term prognostic data. Given the current limitation that well-differentiated liposarcoma has not been completely excluded, heightened vigilance should be maintained for potential recurrence.

CONCLUSION

Esophageal FVP is a rare but potentially dangerous benign tumor of the esophagus. Clinicians should be aware of this condition. Standardized management should focus on three key points: (1) Diagnosis relies on a combination of multiple imaging modalities to avoid missed diagnoses; (2) Treatment should be individualized in selecting the surgical approach; and (3) Pathological examination should include MDM2 testing to differentiate from well-differentiated liposarcoma, which should guide postoperative surveillance accordingly. The literature suggests that for typical FVP cases, endoscopic surveillance should be performed every 1-2 years for up to 10 years; if sarcomatous components are identified, more intensive monitoring is warranted[11]. In the present case, the Sengstaken-Blakemore tube occlusion technique achieved a favorable outcome in assisting the resection of a high, narrow-based esophageal FVP under suspension laryngoscopy, effectively preventing tumor slippage via an intraoperative temporary mechanical barrier. However, this report represents only single-case experience and cannot fully establish the safety, reproducibility, or general applicability of this method. Nonetheless, it should be applied with caution following careful risk-benefit assessment, and its definitive value remains to be validated by accumulated case experience and long-term follow-up.