Successful endoscopic submucosal dissection of a large cavernous hemangioma in the colon

Endoscopic submucosal dissection (ESD) is regarded as a common treatment for complete resection of early gastrointestinal neoplasms [1]. However, few cases have been reported on ESD for resection of cavernous hemangioma in the digestive tract. Here we present a patient with a globular, pedunculated, cavernous hemangioma in the descending colon that was removed successfully en bloc by ESD without any bleeding ([Video 1]).

Video 1 A large cavernous hemangioma in the colon was successfully removed by endoscopic submucosal dissection.

A 50-year-old woman was referred to our hospital for melena. Initial colonoscopy examination revealed a submucosal tumor approximately 20 mm in diameter in the descending colon, mainly characterized by a soft, globular, pedunculated submucosal lesion with a red-purple nodular surface ([Fig. 1 a, b]). Further endoscopic ultrasonography indicated that the lesion originated from the submucosa. The lesion showed high echogenicity, mixed with a small anechogenic area on the inside, and with a decreased blood flow signal ([Fig. 1 c]).

Fig. 1 Colonoscopy and endoscopic ultrasonography examination of the submucosal lesion. a, b A submucosal tumor approximately 20 mm in diameter characterized by a soft, globular, pedunculated submucosal lesion with a red-purple nodular surface. c Endoscopic ultrasonography indicated that the lesion originated from the submucosa and showed high echogenicity, mixed with a small anechogenic area on the inside, and with decreased blood flow signal (yellow arrow).

For treatment, we first performed endoscopic incision of the colonic mucosa using a Hybrid knife (Erbe, Tübingen, Germany) after submucosal injection ([Fig. 2 a]). The submucosal dissection was very carefully performed to avoid damage to the body of the cavernous hemangioma and a clear field was maintained. The lesion was then successfully removed from the colon wall by ESD, as described previously ([Fig. 2 b, c, e]). We used three clips (two from Anrei Medical, Hangzhou, China and one from Micro-Tech, Nanjing, China) for closure of the mucosal defect ([Fig. 2 d]). Finally, histological examination of the resected specimen confirmed cavernous hemangioma ([Fig. 2 f]). The patient was discharged with no further symptoms after 2 days of intravenous antibiotic treatment.

Fig. 2 Colonic cavernous hemangioma was completely removed by endoscopic submucosal dissection (ESD). a An endoscopic incision of the mucosa was performed after submucosal injection. b, c, e The lesion was successfully removed from the colon wall by ESD. d Closure of the mucosal defect. f Histological examination of the resected specimen.

In summary, we believe that this is the first published report of a colonic cavernous hemangioma that has been completely removed by ESD.

Endoscopy_UCTN_Code_CCL_1AD_2AF

Competing interests

None

^* These authors contributed equally to this work.

• Reference

• 1 Mavrogenis G, Hochberger J, Deprez P. et al. Technological review on endoscopic submucosal dissection: available equipment, recent developments and emerging techniques. Scand J Gastroenterol 2017; 52: 486-498