Endoscopic unroofing and mucosal resection for large colonic lipoma with intussusception. An effective hybrid technique. These are my courses. These are our disclosures. These are keywords. Lipomas only account for 4% of benign subepithelial tumors of the gastrointestinal tract. Colonic lipomas are often found incidentally during colonoscopy and are often asymptomatic, and therefore do not require routine colonoscopy or treatment. However, in rare cases, colonic lipoma may grow to the point of being symptomatic. There are several endoscopic treatment options for these large lipomas, each with its own pros and cons. Some recommend an endoscopic polypectomy, but the risk of perforation is high. Moreover, if the lipoma is too large, the field of view and manoeuvrability may be compromised, and it may not even be possible to apply a snare in the first place. Others recommend endoscopic unroofing, a procedure reported in 1997 that involves removal of the upper third of a large lipoma. It is a useful and safe method for the treatment of lipomas. However, unroofing alone can leave tumor remnants behind, and the result in large lipomas may not be as good as expected. Here we present the two-step treatment of a large lipoma by endoscopic unroofing and additional mucosal resection as a safe and effective treatment option even for a lipoma large enough to cause interception. A 74-year-old woman presented with abdominal pain and hematokizia. CT scan revealed a tumor at the sigmoidal column with finding of large bowel interception. Coronoscopy revealed a yellowish subepithelial tumor coated with necrotic white substance at the sigmoidal column. Endoscopic ultrasound revealed a round hyperechoic and homogenous tumor rising from the fourth layer. An excisional biopsy was performed and a diagnosis of lipoma was made. An N-block resection by EMR was initially considered.

endoscopic unroofing

mucosal resection

colonic lipoma

intussusception

two-step treatment