In this video, we showcase the removal of a 7-cm esophageal lipoma in a patient who presented with dysphagia (Eckardt score of 6) and weight loss.
Endoscopic submucosal dissection (ESD) was used to expose the majority of the lipoma; however, due to concerns of both the inability to reach the base of the lipoma and extensive hemorrhage and perforation, the decision to use piecemeal resection using a braided snare was made. The mucosal defect was closed using endoscopic suturing.
This minimally invasive technique can provide care for patients who want to avoid surgery or for those who are not surgical candidates due to significant comorbidities.
Classic ESD provides en bloc resection. There are drawbacks, ESD is technically challenging and is accompanied by additional risks and adverse events. Hybrid ESD can provide an excellent middle ground to both ESD and endoscopic mucosal resection (EMR). In the setting of lipomatous tumors, full en bloc resection is not necessary. Even with subtotal resection, lipoma regrowth is extremely unlikely demonstrated by multiple studies using both ESD and EMR. This makes hybrid ESD well suited to tackle larger variations of this benign tumor.
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