Post written by Syedreza “Reza” Haider, MD, MBA, from Washington University School of Medicine, St. Louis, Missouri, USA.

In this video case, we present the successful endoscopic removal of a large colonic lipoma using the loop-and-let-go technique.

The patient, a 69-year-old woman, had been experiencing intermittent bloating, abdominal pain, and constipation. During colonoscopy, a 50-mm lipoma in the sigmoid colon was identified. Because of concerns about obstruction and intussusception, we decided to proceed with endoscopic management using the loop-and-let-go technique to remove the lipoma safely and effectively.

We felt it was important to showcase this particular video case for several reasons. Large and symptomatic colonic lipomas can be challenging to manage endoscopically. The loop-and-let-go technique provides a promising alternative that minimizes the risks associated with electrocautery during traditional resection methods. We also felt it was important to highlight the use of an endoloop, which can sometimes be challenging.

By presenting this case, we aim to highlight the potential of this technique in managing larger colonic lipomas and to encourage its consideration among endoscopists facing similar cases.

In addition, previous studies focused on smaller lesions, but our case demonstrates the successful application of this technique to a larger lipoma, providing valuable insights for the medical community.

We hope other endoscopists acknowledge this technique as a viable alternative to traditional resection methods. By ligating the lipoma at the base and allowing for auto-amputation, the need for electrocautery is minimized, reducing the risk of adverse events.

We anticipate other endoscopists can use the loop-and-let go technique for various large lesions encountered in the GI tract, particularly when pre-resection diagnosis has been reached, and specimen nonacquisition would not change management. Hopefully, this video inspires endoscopists to familiarize themselves with endoloop and other loop devices that should always be considered in the armamentarium of tissue resection devices.

Large 50-mm sigmoid polypoid mass seen on colonoscopy.

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