Jenson Phung, MD1, Morgan Freeman, MD1, Mohammad Bilal, MD2 1University of Minnesota, Minneapolis, MN; 2Minneapolis VA Medical Center, Minneapolis, MN
Introduction: Colonic lipomas are usually incidental findings during colonoscopy. Lipomas that are ≥ 4 cm can cause symptoms such as obstruction and intussusception. Surgical resection is often recommended in these instances. However, endoscopic resection of larger lipomas has been previously reported using PolyLoop-assisted unroofing technique, snare catheter unroofing/resection, and placement of endoclips prior to resection. Here we describe a novel technique for endoscopic debulking of a large colonic lipoma.
Case Description/Methods: A 63-year-old man with a previously known large colonic lipoma causing recurrent intussusception presented with abdominal pain. The patient had previously declined surgery. Computed tomography (CT) scan of the abdomen demonstrated an 8-cm fat containing mass in the ascending colon. Colonoscopy showed a large trilobed mass in the ascending colon with areas of ulceration, occluding the entire lumen of the colon. The patient refused surgery, and after multidisciplinary discussion, the decision was made to attempt endoscopic resection. A colonoscopy was performed, and attempts to place a PolyLoop around the mass were unsuccessful due to the size and the smooth surface of the mass. Therefore, the decision was made to use an endoscopic submucosal dissection knife to perform a mucosal incision on the surface of the lesion to expose the underlying fatty tissue. The lipoma was eventually exposed, and the fatty tissue was resected piecemeal with a snare. The lipoma was significantly debulked with resolution of the patient’s abdominal pain. Repeat colonoscopy was performed after 8 weeks, and the lesion was significantly smaller. Debulking was performed again using the same technique. Given the size of the lesion was significantly reduced, two PolyLoops were then successfully placed over the lesion to allow for sloughing of the remainder of the lesion. Subsequent colonoscopy after 6 months showed significant improvement in luminal narrowing. The patient did not have any recurrence of intussusception on 6-month follow up.
Discussion: Colonic lipomas do not need resection unless they lead to obstruction or intussusception. In situations where endoscopic resection is challenging with conventional resection techniques, debulking of the lipoma by performing endoscopic mucosotomy to expose the lipomatous tissue followed by snare resection is a safe and effective strategy to manage large lipomas in the gastrointestinal tract.
Figure: Figure 1. A. Large lipoma obstructing the lumen of the ascending colon. B. Initial mucosal incision performed. C. Endoscopic view of the exposed lipoma following mucosotomy. D. Colonic lumen after debulking of lipoma.
Disclosures:
Jenson Phung indicated no relevant financial relationships.
Morgan Freeman indicated no relevant financial relationships.
Mohammad Bilal: Boston Scientific – Consultant.
Jenson Phung, MD1, Morgan Freeman, MD1, Mohammad Bilal, MD2. P0875 - Endoscopic Debulking of a Large Colonic Lipoma Causing Recurrent Intussusception Using Endoscopic Mucosotomy Technique, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
