Two Patients with Large Colonic Lipomas for which Endoscopic Unroofing was Ineffective

Abstract

Endoscopic unroofing is effective for treating large colonic lipomas. However, additional endoscopic resection is occasionally required when the outcomes of initial unroofing are incomplete. The colonoscopy of an 82-year-old woman with abdominal pain revealed a yellowish lipoma of about 20 mm in the transverse colon. The mass was treated by unroofing, but a follow-up colonoscopy 5 days later revealed residual lipoma. One month later, the regenerated surface had become covered with mucosa, and the status of the lipoma had returned to that before unroofing. The colonoscopy of a 74-year-old man with abdominal pain and melena revealed a 50-mm-wide protruding lipoma in the transverse colon. The mucosa of the upper third of the lipoma was excised using an electric knife and snare, which allowed the immediate partial drainage of adipose tissue. Unroofing proceeded, but 7 days later, the unroofed surface had become coated with a white substance, and the residual lipoma required additional endoscopic resection. Colonic lipomas are often asymptomatic. However, patients with abdominal pain and hemorrhage should be treated in consideration of complete resection, but not by unroofing, which could leave a residual tumor. Drainage should be confirmed after unroofing and any residual lipoma should be treated by additional resection.

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

“…Several authors have questioned the efficacy of the unroofing technique. 13,31 Tomiki et al reported two 8 1/1 (100%) 1/1 (100%) 0% -Soares et al, 2011 9 1/1 (100%) N/A 0% -Sugimoto et al, 2012 17 1/1 (100%) 1/1 (100%) 0% -Tomiki et al, 2016 13 0/2 (0%) 2/2 (100%) 0% -EMR:…”

“…Several authors have questioned the efficacy of the unroofing technique 13,31 . Tomiki et al reported two colon lipomas (20 and 50 mm) managed by unroofing.…”

Endoscopic Treatment of Intussusception From Massive Colonic Lipomas via Endoscopic Mucosal Resection: A Case Series

“…11,12 Unroofing and removal using an endoloop are both often deemed safer to EMR and ESD; however, incomplete resection requiring additional subsequent EMR has been reported. 7–9,13 Notably, a vast majority of these studies have focused on lipomas smaller than 8 cm.…”

Endoscopic resection of giant colon lipomas: get rid of the roof!

“…Moreover, tissue from partial resection can still be sent for pathologic evaluation in an effort to confirm the visual diagnosis. Regarding efficacy, there are reports of cases in which reintervention was required, presumably after insufficient unroofing, because re-epithelialization of a limited unroofing site may hamper expulsion of the submucosal content 10, 11. Comparative studies evaluating the different techniques for resection of giant colon lipomas are scarce.…”