Endoscopic debulking of a large colonic lipoma causing recurrent intussusception using endoscopic mucosotomy technique

Colonic lipomas are usually incidental findings during colonoscopy. Lipomas ≥ 4 cm can cause obstruction and intussusception. Surgical resection is often recommended in these instances [1] [2]. However, endoscopic resection of larger lipomas has been reported previously using PolyLoop-assisted unroofing technique, snare catheter unroofing/resection, and placement of endoclips prior to resection [3]. Here, we describe a novel technique for endoscopic debulking of a large colonic lipoma.

A 63-year-old man with a known large colonic lipoma causing recurrent intussusception presented with abdominal pain. He had previously declined surgery. Computed tomography 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 ([Fig. 1]). The patient refused surgery, and after multidisciplinary discussion, the decision was made to attempt endoscopic resection.

Fig. 1 Large lipoma obstructing the lumen of the ascending colon.

A colonoscopy was performed, and attempts to place a PolyLoop (Olympus, Tokyo, Japan) around the mass were unsuccessful due to the size and smoothness 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 ([Fig. 2 a]). The lipoma was eventually exposed, and the fatty tissue was resected piecemeal with a snare ([Fig. 2 b]). The lipoma was significantly debulked with resolution of the patient’s abdominal pain.

Fig. 2 Endoscopic images. a The initial mucosal incision. b The exposed lipoma following mucosotomy.

Repeat colonoscopy was performed after 8 weeks, and the lesion was significantly smaller. Debulking was performed again using the same technique. As the size of the lesion was significantly reduced compared with the original lipoma, two PolyLoops could be successfully placed over the lesion, allowing sloughing of the remainder of the lesion.

Further colonoscopy after 6 months showed significant improvement in luminal narrowing ([Fig. 3], [Video 1]). The patient had no recurrence of intussusception at the 6-month follow-up.

Fig. 3 Endoscopic images. a The lipoma on index colonoscopy. b The colonic lumen after debulking of the lipoma.

Video 1 Endoscopic debulking of a large colonic lipoma causing recurrent intussusception using endoscopic mucosotomy technique.

Endoscopy_UCTN_Code_TTT_1AQ_2AD

Competing interests

The authors declare that they have no conflict of interest.

Acknowledegments

Jenson Phung is incredibly grateful to Dr. Bilal, who has been an inspiring mentor, and without whom this project would not have been possible. Also, many thanks to Morgan Freeman who has been of pivotal help along the way.

• References

• 1 Gould DJ, Morrison CA, Liscum KR. et al. A lipoma of the transverse colon causing intermittent obstruction: a rare cause for surgical intervention. Gastroenterol Hepatol (N Y) 2011; 7: 487-490
• 2 Shi L, Zhao Y, Li W. Endoscopic resection of a giant colonic lipoma with endoloop-assisted unroofing technique: a case report. Medicine (Baltimore) 2018; 97: e10995
• 3 Kim GW, Kwon C-I, Song SH. et al. Endoscopic resection of giant colonic lipoma: case series with partial resection. Clin Endosc 2013; 46: 586-590

Publication History

Article published online:
15 June 2023