Endoscopic treatment of large symptomatic colon lipomas: A systematic review of efficacy and safety

Abstract

Background Various techniques have been described for endoscopic resection of large symptomatic colon lipomas. Lipoma unroofing might provide a safer, more time efficient and easier technique compared to dissection-based techniques, endoscopic mucosal resection (EMR) or loop-assisted resection. The aim of this systematic review was to compare efficacy and safety (endoscopic resolution rates, clinical remission rates and adverse events) of lipoma unroofing with respect to dissection-based techniques, EMR or loop-assisted resection. Methods As most outcomes were binary in nature and several outcomes did not occur in some studies, routine calculation of standard errors in outcome probability was not possible. Therefore, original patient data were extracted, after which efficacy and safety were compared. Results Twenty four studies met the selection criteria, which encompassed 77 lesions (46.8% female, mean age 63 years (interquartile range (IQR) 53–72 years), mean size 45.4 mm (IQR 30.0–60.0 mm). Ten patients underwent unroofing (13.0%), whereas 7 (9.1%), 31 (40.3%) and 29 patients (37.7%) underwent dissection-based techniques, EMR and loop-assisted-snare resection, respectively. Endoscopic resolution rates were 60%, 100% ( p = 0.103), 93.6% ( p = 0.024) and 93.1% ( p = 0.028). Clinical remission rates were identical in all four groups (100%). Amongst patients who underwent EMR and loop-assisted techniques, adverse events were identified in 12.9% ( p = 0.556) and 13.8% ( p = 0.556), respectively, compared to none in the unroofing and dissection-based resection group. Conclusions In patients with large colon lipomas, endoscopic treatment by unroofing, dissection-based resection, EMR and loop-assisted resection provided similar clinical remission rates. Amongst patients undergoing EMR and loop-assisted resection, increased endoscopic resolution rates were seen at the expense of more adverse events, although the latter did not reach statistical significance. Until more reliable comparative data are available, the most optimal resection technique should rely on local expertise and patient profile.

Colonic Lipoma Causing Bowel Intussusception: An Up-to-Date Systematic Review

“…This procedure can be performed both endoscopically (10% of the cases analyzed) and surgically (8%). In the first case, different techniques are possible, such as the “unroofing” dissection of the lipoma with a loop-assisted snare, the “Ligate and Let Go” technique, the endoscopic mucosal resection (EMR), and the endoscopic submucosal dissection (ESD), all with excellent remission rates [ 35 , 36 ]. In the case of surgery, open (mediated colotomy and colonic enterorrhaphy) or transanal “enucleations” can be performed.…”

An Ulcerated Large Colic Lipoma Causing Rectorrhagia Treated With Endoscopic Loop-Assisted Resection

“…In the last approach, the prophylactic use of an endoloop may prevent postpolypectomy bleeding [10]. In a recent systematic review of 24 studies, a total of 77 lipomatous formations were removed using the following techniques: EMR (40.3%), loop-assisted-snare resection (37.7%), unroofing (13%), and dissection-based technique (9.1%) [11]. No statistical significance was observed with regard to the clinical remission rates among patients in all groups.…”

“…No statistical significance was observed with regard to the clinical remission rates among patients in all groups. Patients who underwent loop-assisted techniques developed adverse events in 13.8% of cases [11].…”

UEGWeek: The modern School of Athens

“…6 Moving to a benign, yet sometimes symptomatic condition, whether to treat symptomatic colonic lipoma with unroofing, dissection, endoscopic mucosal resection (EMR), or loop-assisted resection was investigated in a systematic review by Michiel Bronswijk et al, in which a similar clinical remission rate was observed among the different techniques; nevertheless, EMR and loop-assisted resection slightly increased endoscopic resolution rates at the expenses of more adverse events. 7 When it comes to pancreas-related endoscopy, what is the best needle for endoscopic ultrasound (EUS)-guided acquisition of pancreatic solid lesion is still a matter of debate and many characteristics can make the difference. In a randomized trial on 46 patients, two 19G needles were employed: a nitinol-based and a stainless steel one.…”