ENDOSCOPIC MANAGEMENT OF LARGE SYMPTOMATIC COLON LIPOMAS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Aims Various techniques have been described for endoscopic treatment of large symptomatic colon lipomas. On of these techniques, lipoma unroofing, relies on spontaneous intraluminal expulsion, occurring after simple partial snare resection. This approach might provide a safer, easier and more cost effective technique compared to dissection-based techniques, endoscopic mucosal resection (EMR) or loop-assisted resection (LAR). Our aim was to compare efficacy and safety of unroofing with these three endoscopic techniques.

Methods A systematic literary review was performed using an electronic database search. As most outcomes were binary in nature and several outcomes did not occur in some studies, routine calculation of standard errors in outcome probability was not possible. Therefore, original patient data were extracted, after which complete resolution rate and adverse events were compared.

Results Twenty six studies met selection criteria. In total, 96 lesions were identified (50% female, mean age 63 years, mean lesion size 45.0 mm). Four retrospective analyses, 21 case reports and 1 prospective study were included. Baseline characteristics did not differ significantly. Ten patients underwent unroofing (10.4%), whereas 26 patients (28.1%), 31 patients (32.3%) and 29 patients (30.2%) received dissection-based resection, EMR and LAR respectively. Complete resolution rates were 80%, 100% (p = 0.086), 100% (p = 0.068) and 89.7% (p = 0.44). While no adverse events were identified in the unroofing group, dissection-based resection, EMR and LAR led to adverse events in 7.7% (p = 0.668), 12.9% (p = 0.421) and 10.3% (p = 0.552) of cases.

Conclusions Dissection-based techniques, EMR and LAR did not provide a statistically significant increase in complete resection rate and more importantly, led to a higher percentage of adverse events. However, before unroofing can be considered as the primary technique for treatment of large symptomatic colon lipomas, more data are needed to prove a significant benefit in safety. Until then, the most optimal treatment should depend on local expertise.