Endoclip-assisted giant colon lipoma resection

Post written by Shou-jiang Tang, MD, from the Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA.

We reported a case of a symptomatic giant sigmoid colon lipoma (7 cm × 6 cm) that was successfully removed with endoclip assisted dissection. Considering its size, thick stalk, and the possibility of pseudo-pedicle in the stalk, we decided to proceed with endoclip-assisted step-wise pedicle dissection to remove the lipoma. We chose clips with a 16-mm opening arm span for maximal stalk ligation. The patient was discharged to home after the procedure. She did not report bleeding, fever, or pain during follow-up except mild left lower-quadrant discomfort that lasted about 10 hours. All of her obstructive gastrointestinal symptoms resolved the next day after endoscopic resection.

The authors propose that endoclip-assisted step-wise stalk dissection is a viable and safe option in patients with symptomatic large (2-4 cm) and giant (> 4 cm) colon lipomas. Endoclip ligation aims to prevent intra- and post-procedural bleeding, minimizes the risk of perforation due to dissection, especially with the possibility of underlying pseudo-pedicle.

Not infrequently, endoscopists encounter colon lipomas during colonoscopy. These lipomas are usually small (< 2 cm) and appear as yellowish soft submucosal nodules. Colon lipomas are 90% submucosal, but in up to 10% of cases muscularis propria or subserosal layers are involved. As lipomas grow in size, with intestinal peristalsis, they can become pedunculated or form a pedicle or stalk. The vast majority of lipomas are incidental findings, and they do not cause any symptoms. Endoscopic removal is not indicated or necessary. Large (2-4 cm) colon lipomas can potentially cause obstructive symptoms such as pain, bloating, constipation, post-obstructive diarrhea, intussusception, or bleeding. According to a recent review, giant lipomas (> 4 cm) are usually symptomatic. For large and giant pedunculated lipomas, the normal muscular propria layer of the colon surrounding the pedicle can be evaginated into the stalk, forming a pseudo-pedicle. Endoscopic resection of these large and giant lipomas carries a perforation risk as high as 8%.

Read the full article online.

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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