Endoscopic resection of giant esophageal lipoma

Danny Cheriyan, MD, from the Division of Gastroenterology at Duke University Medical Center in Durham, North Carolina, USA shares this VideoGIE case, “Giant esophageal lipoma: endoscopic resection.”

We describe a rare case of a large esophageal lipoma that caused significant dysphagia in a 72-year-old male patient. These lesions are typically small, and are incidentally noted during upper GI endoscopic examination. When they are large enough to cause dysphagia however, aggressive intervention may be required. This particular patient had been referred by another center for EUS examination as part of work-up for surgery. We discussed the possible strategies with the patient and referring physician prior to our procedure.

Following endosonographic examination, which confirmed a mobile, hyperechoic submucosal lesion, the decision was made to endoscopically resect the lipoma. This was done successfully following a submucosal saline and methylene blue injection, followed by prophylactic defect closure with clips. The patient tolerated the procedure well, and no immediate or post-procedural complications were noted. Pathology confirmed a lipoma, and the patients’ symptoms significantly improved on follow-up.

Our case demonstrates that careful endosonographic examination, coupled with an aggressive but measured endoscopic resection is an acceptable approach to large superficial lesions within the upper GI tract. This information is helpful for referring physicians and surgeons to consider when faced with these potentially challenging lesions. It is also important for the patient to be aware that this approach may be possible so that a fully informed decision can be made.

Large superficial lesions within then upper GI tract are endoscopically resectable and may be the preferred route when considering the potential morbidity associated with surgery. EUS guided examination is critical as it helps to define the lesion and determine the optimal interventional approach.

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The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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