Post written by Georgios Mavrogenis, MD, from the Department of Gastroenterology, Mediterraneo Hospital, Athens, Greece.
This video describes the resection of an obstructive duodenal lipoma by means of submucosal tunneling endoscopic resection (STER) and the resection of obstructive colonic lipoma by means of endoscopic submucosal dissection (ESD)
Big lipomas are always challenging to remove. The application of an endoloop is not always feasible. In addition, snare resection bares the risk of bleeding, perforation, or incomplete resection. Therefore, in this video, we illustrate a safe approach for the removal of large sessile duodenal lipoma by STER. This approach achieves enucleation of the lesion and complete sealing of the site of resection by normal mucosa. Therefore, the risk of late perforation or bleeding is less than with standard techniques. The second case illustrates a relatively easy approach of removing a large semi-pedunculated lipoma by means of ESD. Advantages of ESD for colonic lipomas include precision in the depth of cutting, immediate hemostasis of feasible vessels, and recuperation of the specimen.
Endoscopists usually remove lipomas by snare resection or by placing a detachable snare. For cases where these techniques are not feasible, ESD-derived techniques like the ones presented in this video can be applied. In particular, large sessile lesions could be removed by STER and large pedunculated lesions by ESD.
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