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

Kopáčová, Marcela; Rejchrt, Stanislav; Bureš, Jan

doi:10.14712/18059694.2016.1

Cited by 9 publications

(5 citation statements)

References 58 publications

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“…However, concerns about the risk of perforation, bleeding, tumour spillage and high clinical expertise make their widespread application for SELs resection controversial [1, 9]. Unroofing of a SEL removes the overlying mucosa and possibly allows partial resection of the lesion, thereby improving access to the deeper layers [10]. Unroofing can be performed with a needle-knife, snare, cap or banding device.…”

Section: Discussion/conclusionmentioning

confidence: 99%

An Atypical Presentation of a Colonic Lipoma: Avoiding Surgery with a Deeper Endoscopic Look

João¹,

Cunha²,

Gravito-Soares³

et al. 2021

GE Port J Gastroenterol

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Introduction: Colonic lipomas are common mesenchymal tumours. They are usually asymptomatic and incidentally diagnosed during endoscopic or radiological examinations. Taking into account their typical endoscopic and radiological features and benign nature, tissue sampling, resection or follow-up are generally not required. Case Report: A 61-year-old woman with poor surgical fitness presented with colonic subocclusion and lower gastrointestinal bleeding. A colonoscopy performed 1 month earlier showed a large polypoid lesion with necrotic and ulcerated areas occupying the lumen of the proximal ascending colon with inconclusive histology. An abdominopelvic computed tomography scan with intravenous contrast was done revealing a cecal-colonic intussusception of a heterogeneous mass. The patient was successfully managed conservatively. A delayed revision colonoscopy showed a significantly smaller atypical subepithelial lesion with no necrosis or ulceration. A single, large and deep incision with a pre-cut needle-knife® allowed the direct collection of lesion tissue using standard biopsy forceps through the so-called single-incision needle-knife® (SINK) biopsy technique. Histological examination was compatible with submucosal lipoma. After 18 months of follow-up, the patient remains asymptomatic. Discussion/Conclusion: Colonic lipoma complications are rare and can lead to misdiagnosis; in general, they are surgically managed. A conservative approach and a minimally invasive endoscopic procedure allowed a definite diagnosis avoiding the morbidity and mortality of a major surgical intervention in a high-risk patient.

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Section: Discussion/conclusionmentioning

confidence: 99%

An Atypical Presentation of a Colonic Lipoma: Avoiding Surgery with a Deeper Endoscopic Look

João¹,

Cunha²,

Gravito-Soares³

et al. 2021

GE Port J Gastroenterol

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“…Endoscopic unroofing is simple and safe, and a useful method of treatment that also enables pathological examinations [1]. The procedure is applicable to a diagnosis not only of lipomas, but also of submucosal masses such as gastrointestinal stromal tumors, leiomyomas, and neuroendocrine carcinomas [7, 8].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, it is desirable to treat large colonic lipomas with endoscopic resection [1]. Endoscopic submucosal dissection (ESD) is considered to be effective for treating large lipomas [2]; however, ESD is also associated with the risk of perforation and bleeding [3].…”

Section: Introductionmentioning

confidence: 99%

“…Endoscopic unroofing is a simple, safe and effective procedure that comprises the excision of the upper third of a large lipoma to allow remaining adipose tissue to gradually extrude from the resected stump [1, 4, 5, 6]. Nonetheless, the outcomes of this procedure are not always positive, and we describe the failure of unroofing to treat two large colonic lipomas.…”

Section: Introductionmentioning

confidence: 99%

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

Tomiki

Niwa

Nagayasu

et al. 2016

Case Rep Gastroenterol

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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.

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“…Other endoscopic resection techniques carry risks such as perforation, and deroofing is associated with increased risk of an incomplete resection. To address this last issue, we discussed resecting the upper part of the lesion using the deroofing technique, as described in several case reports,14–16 followed by CAL-WR of the remaining portion. However, during endoscopic reassessment in the operating room, the lesion had shrunk, and part of it appeared to have fallen off (figure 3A,B).…”

Section: Treatmentmentioning

confidence: 99%

Colonoscopy-assisted laparoscopic wedge resection for a large symptomatic colonic lipoma

Hanevelt,

de Vos Tot Nederveen Cappel,

ten Kate

et al. 2024

BMJ Case Rep

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A colonic lipoma is an uncommon lesion that is linked with clinical symptoms in only a small portion of patients. Patients with large lipomas are often referred for major surgery, which is associated with significant morbidity and mortality. In this case, we described a female patient with recurrent episodes of gastrointestinal blood loss, abdominal pain and colocolic intussusceptions due to a large, lumen-filling, obstructive lipoma in the splenic flexure. On abdominal CT, a lesion of 3.6 cm was visualised with a fat-like density without solid components. Considering its benign nature, we intended to preserve the colon by deroofing the upper part of the lesion and then performing a colonoscopy-assisted laparoscopic wedge resection. During reassessment, auto-amputation of part of the lesion was observed, most likely as a result of long-lasting mechanical effects, which made it possible to perform solely a wedge resection with an excellent outcome.

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

Cited by 9 publications

References 58 publications

An Atypical Presentation of a Colonic Lipoma: Avoiding Surgery with a Deeper Endoscopic Look

An Atypical Presentation of a Colonic Lipoma: Avoiding Surgery with a Deeper Endoscopic Look

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

Colonoscopy-assisted laparoscopic wedge resection for a large symptomatic colonic lipoma

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