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As a new patient and human who had experience to see and hear for the first time something can be pedunculated, specially pedunculated polyp (what!!!), it’s normally I am wondering what actually that is? I have large pedunculated polyp of the lower esophagus, they told me at the level of Z-line. Off course I know at least that should be removed, so I want to know what is suggested work-up? What kind of precautions should be taken for removing it?

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Work-up for polyp you described should begin during the initial endoscopy, or the time when diagnosis probably was made. Significant difference in diagnosis and work up makes a determination of your polyp, whether it was mucosal or submucosal. There should be preformed biopsy, which will help determinate type. The diagnosis could be obvious even at the time of endoscopy. Also, endoscopic ultrasonography (EUS), can aid significantly in the work-up of possible kinds of tumors. Characteristics, size and possible invasion and relationship to surrounding structures is important in determining the risk for malignancy. If that is necessary EUS can be used for image-guided needle aspiration. Yours pedunculated polyp could be, (as I made the assumption), kind of fibrovascular polyp, because you describe it as large and pedunculated. These are the most common type of intraluminal benign tumor. Pedunculated polyps can occur throughout the esophagus, although they are usually found in the cervical part of esophagus. If the lesions are small they can often be resected endoscopically with a snare. Small in case of pedunculated polyp is equal or lesser then 2-3 cm.
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