Peeling a giant ileal lipoma with endoscopic unroofing and submucosal dissection

Abstract

Lipoma is relatively common in the colon but is less often in the small intestine. Most lipomas are incidentally detected at endoscopy and are usually small and asymptomatic. However, some of them can present with obstruction and/or intussusceptions. Surgical resection is commonly recommended to remove such significant lipomas with a limited pedicle and larger than 2 cm in size, as endoscopic resection may result in unfavorable complications such as intestinal perforations. We report a case of 62-year-old man presenting with hematochezia. Colonoscopy showed a submucosal tumor, about 50 mm in size, in the terminal ileum. A clinical diagnosis of lipoma was established based on the findings of colonoscopy and abdominal computed tomography (CT). As the patient complained of hematochezia and mild iron deficiency anemia associated with repeated tumor prolapse, we decided to remove his lipoma. Consequently, the lesion was completely removed en bloc. Although abdominal CT immediately after removal of the lesion showed a small amount of free air, conservative treatment was successfully carried out for the perforation. Histologically, the removed lesion was a lipoma.

Successful Endoscopic Submucosal Dissection of a Large Terminal Ileal Lipoma

“…Surgical resection, including laparoscopic surgery, is a common treatment for lipomas of the small bowel [16]. A PubMed search for the last 10 years yielded only 2 reports of patients with lipomas in the small intestine treated with endoscopic resection; one was a giant ileal lipoma treated with endoscopic unroofing submucosal dissection [11], and the other was a lipoma of the jejunum removed by endoscopic resection using an SB knife. To our knowledge, no report of ESD for ileal lipoma has been published, although Sugimoto et al [13] reported a case with an ileal adenoma removed with ESD after total colectomy due to familial adenomatous polyposis.…”

“…However, lipoma treatment is required when a lipoma is difficult to distinguish from other malignant tumors or when patients complain of symptoms [6, 7]. Most cases of symptomatic lipomas in the small bowels are treated with surgical resection [8, 9, 10], but a few cases are treated with endoscopic resection because of technological advances in endoscopic procedures and equipment [11, 12]. Endoscopic submucosal dissection (ESD) has recently been developed for en bloc resection of gastric and colonic neoplastic tumors [13, 14].…”

Subacute intestinal obstruction by a giant ileal lipoma treated by endoscopic removal

“…The main limitation is that retrieval of the specimen may not be possible. [5,6] Both these techniques are time-consuming. Endoscopic snare polypectomy of a large lesion in the small intestine is more challenging due to narrower lumen.…”

Unroofing Technique as an Option for the Endoscopic Treatment of Giant Gastrointestinal Lipomas

“…Asymptomatic lipomas do not require any treatment. Symptomatic gastrointestinal lipomas could be removed endoscopically by means of snare polypectomy (5,6,17,18,23,(26)(27)(28)(29)(30) or by endoscopic submucosal dissection (31)(32)(33). Preventive submucosal injection (saline or epinephrine), clipping of a lipoma base and the use of detachable nylon or polyglactin loop could reduce the risk of complications such as bleeding or perforation (28,(34)(35)(36)(37)(38)(39).…”