S4469 Revealing the Hidden Cause of Dysphagia: A Case of Benign Esophageal Polyps (Squamous Papillomas) Misdiagnosed as GERD

Introduction: Esophageal polyps, particularly squamous papillomas, are rare benign lesions within the esophagus that can present with symptoms such as dysphagia, epigastric discomfort, and globus sensation. These lesions are often underrecognized and may be misdiagnosed as more common conditions like gastroesophageal reflux disease (GERD). This case highlights a 32-year-old man diagnosed with benign esophageal polyps, as well as discussing the importance of recognizing squamous papillomas as a rare cause of dysphagia. Case Description/Methods: A 32-year-old man presented with a 6-month history of epigastric discomfort, acid reflux, and chronic sore throat with globus sensation. He experienced a foreign body sensation in his throat and frequent throat clearing. The patient experienced difficulty while swallowing solids and liquids. His appetite and weight were stable but mentioned occasional marijuana use for sleep and uses nicotine pouches daily. Also denied the use of NSAIDS. An esophagram depicted significant gastroesophageal reflux but no esophageal strictures or mass lesions. Due to persistent symptoms, an esophagogastroduodenoscopy was performed, identifying two polyps in the distal esophagus. Polyps were removed using cold snare technique. Revaluation showed complete resolution of his globus sensation and dysphagia. Histopathological examination of the resected polyps revealed benign squamous papillomas with no evidence of dysplasia or inflammation. The lesions were non neoplastic with no malignancy or concerning pathological findings. Discussion: This case emphasizes that benign esophageal polyps, particularly squamous papillomas, are an overlooked cause of dysphagia and globus sensation. Symptoms can mimic more common conditions like GERD or chronic pharyngitis, delaying diagnosis. In this patient, the initial diagnosis of GERD delayed the identification of esophageal polyps. The endoscopic removal of the polyps resolved the patient’s symptoms confirming the benign lesions. The effectiveness of minimally invasive management for benign esophageal lesions emphasizes the need to consider squamous papillomas in the differential diagnosis when patients present with unexplained dysphagia and globus sensation. This case shows how important early diagnosis and treatment of these benign lesions can greatly improve patient outcomes and also avoid unnecessary treatments for more common esophageal disorders.