Journal of Clinical Gastroenterology and Treatment
"Endoscopic Exposure Treatment" for a Small Colonic Lipoma
Toshiro Fukui*
Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Hirakata, Japan
*Corresponding author:
Toshiro Fukui, Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 573-1010, Japan, Tel: 81-72-804-0101, Fax: 81-72-804-2524, E-mail: fukuitos@hirakata.kmu.ac.jp
J Clin Gastroenterol Treat, JCGT-1-005, (Volume 1, Issue 1), Clinical Image; ISSN: 2469-584X
Received: August 21, 2015 | Accepted: September 22, 2015 | Published: September 25, 2015
Citation: Fukui T (2015) "Endoscopic Exposure Treatment" for a Small Colonic Lipoma. J Clin Gastroenterol Treat 1:005. 10.23937/2469-584X/1510005
Copyright: © 2015 Fukui T. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Keywords
Colon, Lipoma, Treatment, Colonoscopy
Lipomas form lobulated masses enclosed by thin and fibrous capsules. Colonic lipomas are usually discovered on colonoscopy, and gentle palpation with biopsy forceps reveals soft nature of the submucosal mass. Submucosal lipomas are usually not fixed to the underlying fascia. Large colonic ones may manifest as luminal obstruction, intussusception, volvulization or hemorrhage. Nonsurgical therapy includes endoscopic treatment for submucosal tumors in gastrointestinal tracts. In particular, the unroofing technique (cutting off the upper part of tumors) is usually applied for the diagnosis of submucosal tumors [1]. For treatment purposes, the unroofing technique is applicable to lipomas, which may incidentally resolve [2], but additional treatment will be often required. Colonoscopic snare removal has been described, but may be associated with perforation if the base is broad [3]. Although the outcome and prognosis are excellent for benign lipomas, they may recur if the removal was incomplete. The fibrous capsule must be completely removed to prevent recurrence. Therefore, advanced safer and more effective treatments have been preferred.
As an improved unroofing technique, I have successfully pulled out and exposed the whole capsuled 10 mm diameter lipoma to lumen of the colon using only biopsy forceps and left it without further treatment (Figure 1). One year later, the lipoma completely disappeared with a small scar (Figure 2), also confirmed by biopsies.
.
Figure 1: A colonic lipoma before (A), in the process of (B, C) and after "endoscopic exposure treatment (D)." After unroofing the mucosal layer by biopsy forceps, the fat tissue became naked (B). The operator gripped the submucosal lipoma alone and pulled it out (C). The whole capsuled lipoma was exposed to lumen of the colon (D).
View Figure 1
"Endoscopic exposure treatment" appears to be a possible novel therapy for non-stalked and broad-based small colonic lipomas, and advantages of this method are simpleness, safety, and completeness. We should consider the efficacy, safety and long-term prognosis of endoscopic treatment under the state of the respective colonic lipomas.
References
-
Lee CM, Kim HH (2014) Minimally invasive surgery for submucosal (subepithelial) tumors of the stomach. World J Gastroenterol 20: 13035-13043.
-
Hizawa K, Matsumoto T, Kouzuki T, Suekane H, Esaki M, et al. (2000) Cystic submucosal tumors in the gastrointestinal tract: endosonographic findings and endoscopic removal. Endoscopy 32: 712-714.
-
Lee KJ, Kim GH, Park do Y, Shin NR, Lee BE, et al. (2014) Endoscopic resection of gastrointestinal lipomas: a single-center experience. Surg Endosc 28: 185-192.
