Esophageal Polyp in Young Adult Male - Diagnostic and Management Challenges

Case at a Glance

A 34-year-old male presents with an incidentally discovered esophageal polyp that remains unbiopsied after 4 months due to healthcare access barriers. Patient is asymptomatic and seeking guidance on malignancy risk and treatment urgency.

Patient's Story

The patient reports discovery of an esophageal polyp/mass 4 months prior during what appears to have been an upper endoscopy. He remains completely asymptomatic at present. The initial examining physician recommended removal but did not perform a biopsy at the time of discovery. The patient expresses significant anxiety about potential malignancy and whether the lesion may have grown during the intervening months. He has been unable to obtain specialty follow-up due to insurance limitations but has recently changed coverage and expects to be seen within the next month.

Initial Assessment

Asymptomatic 34-year-old male with endoscopically identified esophageal polyp of unknown histology. Initial provider recommended excision but biopsy was deferred. Patient reports difficulty accessing appropriate specialist care due to insurance constraints.

The Diagnostic Journey

The patient's case highlights common challenges in healthcare navigation. The initial provider was unable to locate an appropriate specialist within the patient's insurance network for polyp removal. Academic medical centers were suggested as potential options for complex cases. The patient ultimately had to change insurance plans to gain access to appropriate specialty care.

Final Diagnosis

Esophageal polyp - histologic diagnosis pending tissue sampling

Treatment Plan

Patient scheduled for gastroenterology consultation following insurance approval. Plan includes repeat upper endoscopy with tissue sampling via biopsy or polypectomy depending on lesion characteristics. The consulting gastroenterologist will determine the most appropriate approach for both diagnostic sampling and therapeutic intervention based on polyp size, location, and morphology.

Outcome and Follow-up

Patient counseled that while waiting periods can cause anxiety, most esophageal polyps in young, asymptomatic patients are benign. The brief delay (4-5 months total) is unlikely to significantly impact outcomes if malignancy were present. Definitive histologic diagnosis and treatment planned for upcoming specialty consultation. Patient advised to monitor for any new symptoms such as dysphagia, odynophagia, or weight loss in the interim.