ESD/Submucosal Endoscopy-ENDOSCOPIC SUBMUCOSAL DISSECTION OF GIANT COLONIC LIPOMA

Video Transcription

Endoscopic submucosal dissection of giant colonic lipoma Our authors have nothing to discuss.  Giant colonic lipomas may cause abdominal pain, constipation, interception, or biopsection. For symptomatic lipoma, endoscopic resection is preferred over surgery if it is possible.  This is proposed algorithm for endoscopic resection of GI lipoma. The morphology and size should be considered.  If it is pedunculated lipoma that is catchable with the endor loop, treatment options are loop and let go or loop and resection.  But if it is not catchable with the endor loop, ESD could be performed.  Here we present a case with intermittent abdominal pain for 1 year. CT scan revealed colon-coli interception with an 8 cm fatty mass as the leading point.  Colonoscopy shows a giant pedunculated yellowish submucosal tumor at the ascending colon. It shows a positive payload sign.  Based on CT and colonoscopic findings, the most likely diagnosis was a giant lipoma.  After discussion with the patient, we decided to perform endoscopic resection. The first treatment option was loop assisted resection.  But if the tumor could not be caught with the endor loop, the treatment plan will be changed to ESD.  During the procedure, the tumor was too large to be caught with the endor loop.  So ESD was performed.  We altered the patient's position that allowed the cavity to add injection.  Submucosal injection was performed with Glycelol mixed with Indicocamide and Adrenaline.  We used the digitized endoscopic knife for making the incision and dissecting along the base of the tumor.  The large feeding vessel was cauterized with coagulating forceps.  The scissor-type and insulated tip knife were also helpful during the latter part of the dissection.  This is the final cut of the procedure.  The wound was caused with the endoscopic clips.  The tumor was retrieved with Pentapod clasping forceps.  The endoscopic clip was used to remove the tumor. The tumor was retrieved with Pentapod clasping forceps.  Pathologic examination confirmed the diagnosis of lipoma.  The patient was discharged on postoperative day 2 without complication. At 2 months follow-up, the patient's abdominal pain was resolved.  Giant chronic lipoma may not be caused with endorlobe if it is too large. ESD is a feasible treatment for these cases.  Set the patient's position that allowed the cavity to add injection and beware the large feeding vessel at the center of the lipoma.  In conclusion, endoscopic submucosal dissection is a safe and effective treatment for patients with giant chronic lipoma.

Video Summary

The video is about the endoscopic submucosal dissection (ESD) of a giant colonic lipoma. Lipomas in the colon can cause symptoms such as abdominal pain and constipation. The preferred treatment for symptomatic lipomas is endoscopic resection if possible. The video presents a case of a patient with intermittent abdominal pain for a year. CT scan and colonoscopy confirmed the diagnosis of a giant lipoma. Initially, loop-assisted resection was attempted, but due to the size of the tumor, ESD was performed instead. The procedure involved submucosal injection and dissection of the tumor using various endoscopic tools. Pathologic examination confirmed the diagnosis, and the patient was discharged without complications. ESD is considered a safe and effective treatment for giant colonic lipomas.

Asset Subtitle

Honorable Mention

Keywords

endoscopic submucosal dissection

giant colonic lipoma

abdominal pain

constipation

endoscopic resection