Large pedunculated esophageal and hypopharyngeal polyps are uncommon. Clinical presentation most commonly includes dysphagia and mass regurgitation. If left untreated the patient may develop polyp aspiration complicated by fatal asphyxiation. Diagnosis has depended on endoscopy and barium swallow historically; however, these procedures may fail to provide a diagnosis. In recent years computerized tomographic scan and magnetic resonance imaging have proved reliable methods of diagnosis. These polyps are located predominantly in the upper esophagus and frequently are comprised of a fibrous component. Malignant potential is low. Resection of these lesions is warranted; it may be approached endoscopically if feasible or surgically through a cervical or thoracotomy approach, depending on the location. Recurrence is rare. To our knowledge, this is the largest review of large esophageal polyps, including 110 reported cases in the literature.