Extensive esophageal papillomatosis is a rare condition with uncertain pathophysiology. We present a case involving a 78-year-old woman, with no notable habits or addictions, who presented with dysphagia and weight loss. She was diagnosed with extensive esophageal papillomatosis, causing esophageal substenosis. Diagnosis of dysplasia in such cases are challenging, and management of the risk of malignant transformation remains uncertain.