1
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Li M, Chen C, Deng D, Ni X, Yin J, Chen L, Zhu Z. An unusual cause of life-threatening upper gastrointestinal bleeding. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024; 116:54-55. [PMID: 37073705 DOI: 10.17235/reed.2023.9645/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
A previously healthy 56-year-old female was hospitalized with intermittent melena and transient syncope for 1-month duration. Physical examination on admission showed heart rate was 105 beats per minute and blood pressure was 89/55 mmHg. Her hemoglobin was 6.7 g/dl. She received fluid infusion, blood transfusion, acid suppression and hemostasis treatment. Abdominal enhanced computed tomography (CT) demonstrated a well-defined mass with uniform adipose density in the antrum measuring 4 × 5 cm. Gastroscopy revealed a giant submucosal tumor with superficial ulceration in anterior wall of the gastric antrum. Endoscopic ultrasound (EUS) showed a homogeneous, well-circumscribed, hyperechoic mass originated from the submucosa layer. Distal partial gastrectomy was performed. Postoperative histopathology examination of the resected specimen revealed the tumor was composed of closely arranged and uniformly shaped proliferative mature adipocytes, which located in the submucosa layer with superficial mucosal ulcer. The patient was diagnosed as giant gastric lipoma with superficial ulcer and no symptoms was observed in 3 months follow-up.
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Affiliation(s)
- Min Li
- Dalian Medical University
| | - Chaowu Chen
- Endoscopy Center. Gastroenterology, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, China
| | - Denghao Deng
- Gastroenterology, Northern Jiangsu People's Hospital Affiliated to Yangzhou University
| | - Xiufan Ni
- Gastroenterology, Northern Jiangsu People's Hospital Affiliated to Yangzhou University,
| | - Jian Yin
- Gastroenterology, Northern Jiangsu People's Hospital Affiliated to Yangzhou University,
| | - Lei Chen
- Gastroenterology, Northern Jiangsu People's Hospital Affiliated to Yangzhou University,
| | - Zhen Zhu
- Gastroenterology, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, China
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2
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Lan Y, Zhao S, Xu H. Use of simple endoscopic ligation to successfully remove a large torsional colonic lipoma causing intussusception. Endoscopy 2023; 55:E1150-E1151. [PMID: 37923400 PMCID: PMC10624558 DOI: 10.1055/a-2194-4717] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Yadi Lan
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Shulei Zhao
- Department of Gastroenterology, Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Hongwei Xu
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, China
- Department of Gastroenterology, Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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3
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Haider S, Peller M, Lamm V, Bazarbashi AN. Loop-and-let-go technique for the management of symptomatic large colonic lipoma. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2023; 8:325-327. [PMID: 37575145 PMCID: PMC10422078 DOI: 10.1016/j.vgie.2023.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Video 1We depict (1) identification of a large lipoma in the sigmoid colon; (2) radial echo endoscopy confirming diagnosis; (3) removal with the loop-and-let-go technique; (4) ex vivo demonstration of the technique; and (5) an interval follow-up demonstrating healing of the lesion.
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Affiliation(s)
- Syedreza Haider
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew Peller
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri
| | - Vladimir Lamm
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri
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4
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Furuta A, Omoto S, Inoue T, Yanai M, Iwabe H, Takihara H, Ishibashi K, Tanaka H, Matsuura K, Ogata S, Yokomura A, Hoshikawa M, Kono M, Koriyama T, Tazawa T, Tsuyuguchi E, Yamasaki Y, Esumi S, Tsuruta Y, Shishimoto T, Yamamoto M, Ono W. Successful endoscopic submucosal dissection of colorectal lipoma with an overlying adenoma. JGH Open 2023; 7:456-457. [PMID: 37359118 PMCID: PMC10290265 DOI: 10.1002/jgh3.12901] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/26/2023] [Indexed: 06/28/2023]
Abstract
We report the case of a 65-year-old woman whose colonoscopy revealed a soft submucosal tumor approximately 7 cm in diameter in the ascending colon with an overlying flat lesion. The tumor was diagnosed as a lipoma with an overlying adenoma. Endoscopic submucosal dissection (ESD) was performed. Pathological examination revealed that the epithelium was a low-grade tubulovillous adenoma, while the submucosal yellow tumor was a lipoma. ESD appears to be a safe and effective treatment for colorectal lipomas overlying lipomas with colorectal adenomas.
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Affiliation(s)
- Akito Furuta
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Shunsuke Omoto
- Department of GastroenterologyKindai University Faculty of MedicineOsaka‐sayamaJapan
| | - Taro Inoue
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Mitsuru Yanai
- Department of PathologySapporo Tokushukai HospitalSapporoJapan
| | - Hideo Iwabe
- Department of internal medicineKamagaya General HospitalKamagayaJapan
| | | | - Kohei Ishibashi
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Hironori Tanaka
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Ko Matsuura
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Shunsuke Ogata
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Akitaka Yokomura
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Masato Hoshikawa
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Michihito Kono
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Takasi Koriyama
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Tomohiko Tazawa
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Eri Tsuyuguchi
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Yasuo Yamasaki
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Shun Esumi
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Yoshimasa Tsuruta
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | | | - Masaki Yamamoto
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Wataru Ono
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
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5
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Kobayashi R, Inoue K, Hirose R, Doi T, Harusato A, Dohi O, Yoshida N, Uchiyama K, Ishikawa T, Takagi T, Yasuda H, Konishi H, Morinaga Y, Itoh Y. Obscure gastrointestinal bleeding from a large jejunal lipoma treated using an endoscopic unroofing technique with double balloon enteroscopy: a case study. Clin J Gastroenterol 2023; 16:32-38. [PMID: 36369458 DOI: 10.1007/s12328-022-01724-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 10/15/2022] [Indexed: 11/13/2022]
Abstract
Small intestinal lipomas are rare, but may cause obscure gastrointestinal bleeding. The endoscopic unroofing technique excises only the upper third of the lipoma and allows both histological confirmation and complete treatment with minimal risk of perforation. We present a rare case of obscure gastrointestinal bleeding caused by a jejunal lipoma. A 75-year-old man on antiplatelet therapy presented to our department with melena and anemia. Computed tomography revealed he had a 45-mm jejunal submucosal tumor with fat attenuation. Endoscopic resection using an endoscopic unroofing technique with double balloon enteroscopy was successfully performed. The tumor was confirmed to be a lipoma.
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Affiliation(s)
- Reo Kobayashi
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Ken Inoue
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kamigyo-Ku, Kyoto, 602-8566, Japan.
| | - Ryohei Hirose
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Toshifumi Doi
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Akihito Harusato
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Osamu Dohi
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Naohisa Yoshida
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Kazuhiko Uchiyama
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Takeshi Ishikawa
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Tomohisa Takagi
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Hiroaki Yasuda
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Hideyuki Konishi
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Yukiko Morinaga
- Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshito Itoh
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kamigyo-Ku, Kyoto, 602-8566, Japan
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6
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Muacevic A, Adler JR, Alsolmi AA, Fakhri AF. Duodenal Lipoma As Upper Gastrointestinal Bleeding Presentation: Case Report and Review of the Literature. Cureus 2023; 15:e33996. [PMID: 36811043 PMCID: PMC9939013 DOI: 10.7759/cureus.33996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 01/22/2023] Open
Abstract
Duodenal lipomas (DLs) are rare benign nonepithelial tumors that account for 4% of all gastrointestinal (GI) lipomas. DLs can occur in any part of the duodenum but most commonly arise in the second part of the duodenum. They are usually asymptomatic and discovered incidentally but may present with GI hemorrhage, bowel obstruction, or abdominal pain and discomfort. The diagnostic modalities can be based on radiological studies and endoscopy with the aid of endoscopic ultrasound (EUS). DLs can be managed either endoscopically or surgically. We report a case of symptomatic DL presenting with upper GI hemorrhage along with a review of the literature. We report a case of a 49-year-old female patient who presented with a one-week history of abdominal pain and melena. Upper endoscopy revealed a single, large pedunculated polyp with an ulcerated tip in the first part of the duodenum. EUS confirmed features suggestive of a lipoma, including an intense homogeneous hyperechoic mass originating from the submucosa. The patient underwent endoscopic resection, with excellent recovery. The rare occurrence of DLs requires a high index of suspicion and radiological endoscopic assessment to rule out invasion into the deeper layers. Endoscopic management is associated with good outcomes and a decreased risk of surgical complications.
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7
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Chen ZH, Lv LH, Pan WS, Zhu YM. Spontaneous expulsion of a duodenal lipoma after endoscopic biopsy: A case report. World J Gastroenterol 2022; 28:5086-5092. [PMID: 36160650 PMCID: PMC9494927 DOI: 10.3748/wjg.v28.i34.5086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/24/2022] [Accepted: 08/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastrointestinal (GI) lipomas are benign submucosal tumors of mature adipocytes that arise mainly in the colon and stomach, sometimes in the ileum and jejunum, and rarely in the duodenum. Patients with symptomatic lipomas require endoscopic or surgical treatment. Spontaneous expulsion of lipomas after biopsy is a rare condition that has limited case reports.
CASE SUMMARY A 56-year-old man presented to our hospital with intermittent postprandial epigastric fullness. Esophagogastroduodenoscopy (EGD) revealed a 10-mm soft yellowish submucosal lesion with the “pillow sign,” located in the second portion of duodenum. Endoscopic ultrasonography (EUS) using a 12-MHz catheter probe showed a hyperechoic, homogenous, and round solid lesion (OLYMPUS EUS EU-ME2, UM-DP12-25R, 12-MHz radial miniprobe, Olympus Corporation, Tokyo, Japan). Deep biopsy was performed using the bite-on-bite technique with forceps. Histological examination was compatible with submucosal lipoma. The lesion spontaneously expelled 12 d after the biopsy. Follow-up EUS performed after 2 mo confirmed this condition.
CONCLUSION Deep biopsy could lead to spontaneous GI lipoma expulsion. This might be the first step in lipoma diagnosis and treatment.
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Affiliation(s)
- Zhi-Hao Chen
- Department of Gastroenterology, Zhejiang Provincial People’s Hospital, Hangzhou 310014, Zhejiang Province, China
- Affiliated Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Li-Hong Lv
- Department of Gastroenterology, Xianju County People’s Hospital, Taizhou 317300, Zhejiang Province, China
| | - Wen-Sheng Pan
- Department of Gastroenterology, Zhejiang Provincial People’s Hospital, Hangzhou 310014, Zhejiang Province, China
- Affiliated Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Yi-Miao Zhu
- Department of Gastroenterology, Zhejiang Provincial People’s Hospital, Hangzhou 310014, Zhejiang Province, China
- Affiliated Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
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8
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Huang C, Steinhauser C, Bush A, Laczek J. Loop-and-Let-Go: Treatment of a Large Colonic Lipoma After Unsuccessful Unroofing. ACG Case Rep J 2022; 9:e00848. [PMID: 36061250 PMCID: PMC9433057 DOI: 10.14309/crj.0000000000000848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 07/14/2022] [Indexed: 01/01/2024] Open
Abstract
Gastrointestinal lipomas are benign subepithelial tumors arising from adipose tissue. Most colonic lipomas are clinically silent and do not require intervention. However, if the lipomas are large or symptomatic, removal can be considered. Of the endoscopic techniques available, endoscopic ligation, also known as "loop-and-let-go," provides a safe and easy alternative to other endoscopic therapies and does not require any specialized equipment or advanced training. We describe a case of a patient found to have large colonic lipoma that recurred after endoscopic unroofing but was successfully treated with "loop-and-let-go."
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Affiliation(s)
- Cherry Huang
- Department of Medicine, Division of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, MD
| | - Christina Steinhauser
- Department of Medicine, Division of Gastroenterology/Hepatology, Walter Reed National Military Medical Center, Bethesda, MD
| | - Allison Bush
- Department of Medicine, Division of Gastroenterology/Hepatology, Walter Reed National Military Medical Center, Bethesda, MD
| | - Jeffrey Laczek
- Department of Medicine, Division of Gastroenterology/Hepatology, Walter Reed National Military Medical Center, Bethesda, MD
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9
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Shimura T, Okubo T, Okuda Y, Iwasaki H, Katano T, Kato A, Kataoka H. Endoscopic submucosal dissection followed by laparoscopic collection of a giant duodenal lipoma causing repeated pancreatitis. Endoscopy 2022; 54:E346-E347. [PMID: 34282587 DOI: 10.1055/a-1540-6864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Takaya Shimura
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tomotaka Okubo
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yusuke Okuda
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroyasu Iwasaki
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takahito Katano
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akihisa Kato
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiromi Kataoka
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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10
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Belabbes F, Abdallaoui Maane L, Al Bouzidi A, El Idrissi Lamghari A, Rouibaa F. Endoscopic Resection of a Large Colonic Lipoma Simulating a Tumor Revealed by Hemorrhage: A Case Report and Literature Review. Cureus 2022; 14:e24987. [PMID: 35719757 PMCID: PMC9190023 DOI: 10.7759/cureus.24987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 11/21/2022] Open
Abstract
Lipomas of the colon are benign tumors of the digestive tract. They are usually asymptomatic, and often discovered incidentally during a colonoscopy. However, lipomas larger than 2 cm may present with abdominal pain, bowel changes, and rectal bleeding. They may mimic cancer, depending on multiple factors including tumor size, location, and complications, which often makes preoperative diagnosis difficult. In this report, we discuss the case of a 34-year-old woman who presented with paroxysmal abdominal pain in the left iliac fossa withmoderate hematochezia that had been evolving for six months. The patient denied melena or hematemesis, and she had no significant medical history. Colonoscopy revealed a large polyp of over 5 cm located 40 cm from the anal margin. She underwent endoscopic resection without complications. The histological examination confirmed the lipomatous nature. An accurate preoperative diagnosis of lipomas is necessary.It can often be difficult to choose between endoscopic and surgical treatment. The choice of treatment depends on the size and location of the tumor and complications. Endoscopic resection may obviate the need for surgery and can potentially reduce surgical morbidity. We aimed to report and discuss the management of this patient who underwent endoscopic resection for a large mass with a definitive pathology of colonic lipoma.
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11
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The Diagnosis of Small Gastrointestinal Subepithelial Lesions by Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy. Diagnostics (Basel) 2022; 12:diagnostics12040810. [PMID: 35453857 PMCID: PMC9027519 DOI: 10.3390/diagnostics12040810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 12/02/2022] Open
Abstract
Endoscopic ultrasonography (EUS) has been widely accepted in the diagnosis of all types of tumors, especially pancreatic tumors, lymph nodes, and subepithelial lesions (SELs). One reason is that the examination can provide a detailed observation, with tissue samples being immediately obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Many SELs are detected incidentally during endoscopic examinations without symptoms. Most SELs are mesenchymal tumors originating from the fourth layer, such as gastrointestinal stromal tumors (GISTs), leiomyomas, and schwannomas. GISTs are potentially malignant. Surgical treatment is recommended for localized GISTs of ≥20 mm. However, the indications for the diagnosis and follow-up of GISTs of <20 mm in size are controversial. There are several reports on the rapid progression or metastasis of small GISTs. Therefore, it is important to determine whether a SEL is a GIST or not. The main diagnostic method is EUS-FNA. Recently, endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) using a new biopsy needle has been reported to obtain larger tissue samples. Additionally, various biopsy methods have been reported to have a high diagnostic rate for small GISTs. In local gastric SELs, regardless of the tumor size, EUS can be performed first; then, EUS-FNA/B or various biopsy methods can be used to obtain tissue samples for decision-making in relation to therapy and the follow-up period.
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12
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Ko YL, Matsuoka H, Nomaru R, Imakiire S, Sakisaka H, Matsuoka S, Kuno N, Abe K, Funakoshi S, Ishida Y, Ishibashi H, Koga K, Saito T, Takeshita M, Hirai F. Observation of the drainage process of the residual lipoma after endoscopic unroofing technique during colonoscopic evaluation of post-procedural hematochezia. Clin J Gastroenterol 2022; 15:407-412. [PMID: 35076862 DOI: 10.1007/s12328-022-01594-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/08/2022] [Indexed: 10/19/2022]
Abstract
A 57-year-old man was referred to our hospital for further management of a subepithelial lesion noted on colonoscopy. He underwent endoscopic treatment of unroofing technique, in which the protruding portion of the tumor was partially resected. Due to a small amount of hematochezia, colonoscopy was performed to re-evaluate the lesion post-treatment. This enabled the observation of the drainage process of the residual lipoma. Remission was achieved and confirmed 8 months after the treatment. Endoscopic unroofing technique has been reported as a safe and effective method of treating lipomas, particularly large ones. To the best of our knowledge, this is the first endoscopic unroofing case in which the drainage process of the residual lipoma was observed and the remission of the lesion was confirmed.
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Affiliation(s)
- Yi-Ling Ko
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Hiroki Matsuoka
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Ryohei Nomaru
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - So Imakiire
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Hideto Sakisaka
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Satoshi Matsuoka
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Nobuaki Kuno
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Koichi Abe
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Sadahiro Funakoshi
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Yusuke Ishida
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Hideki Ishibashi
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Kaori Koga
- Department of Pathology, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Tetsuhiro Saito
- Ai Clinic of Internal Medicine and Gastroenterology, 1 Chome-6-24 Komodanishi, Iizuka, Fukuoka, 820-0017, Japan
| | - Morishige Takeshita
- Department of Pathology, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan
| | - Fumihito Hirai
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, 7 Chome-45-1 Nanakuma, Jonan Ward, Fukuoka, 814-0180, Japan.
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13
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Yang B, Jiang F, Lu P, Han H. Minimally invasive management of large duodenal lipoma: endoscopic submucosal dissection. J Int Med Res 2021; 49:3000605211066397. [PMID: 34939876 PMCID: PMC8721732 DOI: 10.1177/03000605211066397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective This study was performed to compare the clinical outcomes of large duodenal lipomas (DLs) of ≥2 cm between endoscopic submucosal dissection (ESD) and endoscopic full-thickness resection (EFTR). Methods This retrospective study included patients who underwent endoscopic resection of large DLs from June 2017 to March 2021 at our hospital. Clinicopathologic features, clinical outcomes, and follow-up endoscopy findings were retrospectively reviewed. Results Twenty-three patients (12 men) with a mean age of 57.4 years were included. The median tumor size was 28.4 ± 13.3 mm. ESD was performed in 19 patients, and EFTR was performed in 4. Complete resection was achieved in 21 patients. The operative time and postoperative hospital stay were significantly shorter in the ESD than EFTR group. Four patients in the EFTR group developed a fever; no other adverse events occurred. No patients required surgical intervention. During the average follow-up of 21.1 months, no residual tumor, recurrence, or metastasis was observed. Conclusion Both ESD and EFTR provide minimally invasive, localized treatment of selected DLs. ESD might have some advantages in resecting large DLs in terms of procedure time and hospitalization.
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Affiliation(s)
| | | | | | - Huazhong Han
- Huazhong Han, Department of General Surgery, Shanghai Xuhui Center Hospital, 966 Huaihai Road (M), Xuhui District, Shanghai 200030, China.
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14
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Deshmukh A, Elmeligui A, Parsa N, Tejedor-Tejada J, Nieto J. Successful removal of a giant esophageal lipoma with hybrid endoscopic submucosal dissection. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2021; 6:398-400. [PMID: 34527835 PMCID: PMC8431273 DOI: 10.1016/j.vgie.2021.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Video 1Endoscopic submucosal dissection of a giant esophageal lipoma.
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Affiliation(s)
- Ameya Deshmukh
- Department of Internal Medicine, Saint Louis University - SOM, St. Louis, Missouri
| | - Ahmed Elmeligui
- Division of Gastroenterology, Hepatology and Endoscopy, Kasr Alainy School of Medicine, Cairo, Egypt
| | - Nasim Parsa
- Division of Gastroenterology and Hepatology, University of Missouri Health System, Columbia, Missouri
| | - Javier Tejedor-Tejada
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Jose Nieto
- Borland Groover Clinic, Jacksonville, Florida
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15
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Nabi Z, Ramchandani M, Darisetty S, Reddy DN. Endoscopic Resection of a Large Submucosal Tumor Causing Intermittent Gastric Outlet Obstruction Using a Novel Radiofrequency Enabled Device. Dig Dis 2021; 40:119-122. [PMID: 33721864 DOI: 10.1159/000515855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/15/2021] [Indexed: 02/02/2023]
Abstract
Gastric lipomas are rare benign tumors and account for 1-3% of all benign gastric tumors. Majority of the gastric lipomas are asymptomatic and do not demand resection. However, large gastric lipomas may present with upper gastrointestinal bleeding and more rarely gastric outlet obstruction. Traditionally, surgery has been utilized for the management of giant gastric lipomas. More recently, endoscopic techniques are increasingly utilized for the resection of gastric submucosal lesions. Here we describe a case with large gastric lipoma who presented with symptoms suggestive of gastric outlet obstruction. Gastroscopy revealed a large (6 cm) submucosal lesion with a broad peduncle located in antrum. The tumor was prolapsing into duodenum thereby, completing occluding the pylorus. In this case, we performed endoscopic submucosal dissection using a novel, bipolar radiofrequency device. The dissection was completed without any complications.
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Affiliation(s)
- Zaheer Nabi
- Asian Institute of Gastroenterology, Hyderabad, India
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16
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Kim GH. Systematic Endoscopic Approach for Diagnosing Gastric Subepithelial Tumors. Gut Liver 2021; 16:19-27. [PMID: 33707348 PMCID: PMC8761929 DOI: 10.5009/gnl20296] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/28/2020] [Accepted: 01/05/2021] [Indexed: 11/06/2022] Open
Abstract
Subepithelial tumors (SETs) are commonly encountered during upper gastrointestinal endoscopy, especially during national gastric cancer screening programs in Korea. Although the majority of SETs are benign, endoscopists harbor concerns regarding whether a SET is benign or malignant because the diagnosis cannot be established on the basis of routine endoscopic biopsy findings. The differential diagnosis of SETs is important, beginning with meticulous endoscopic examination, including the evaluation of the location, macroscopic shape, color, surface characteristics, mobility, consistency, and size of the tumors. The yield of endoscopic biopsy increases with the use of the bite-on-bite technique for SETs without the rolling or tenting sign, with large openings, and with erosion or ulceration. In this review, a systematic approach for the diagnosis of gastric SETs during conventional endoscopy is introduced.
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Affiliation(s)
- Gwang Ha Kim
- Department of Internal Medicine, Pusan National University College of Medicine, and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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17
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Tada N, Kobara H, Masaki T. Modified endoscopic unroofing enucleation using nylon ring traction for a large gastric lipoma. Dig Endosc 2021; 33:e34-e35. [PMID: 33368688 DOI: 10.1111/den.13904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Naoya Tada
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Hideki Kobara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Tsutomu Masaki
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
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18
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Muramoto T, Negishi R, Takita M, Minato Y, Ohata K. Successful endoscopic submucosal dissection for a huge lipoma in the terminal ileum. VideoGIE 2020; 5:575-576. [PMID: 33204923 PMCID: PMC7650044 DOI: 10.1016/j.vgie.2020.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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19
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Bronswijk M, Vandenbroucke AM, Bossuyt P. Endoscopic treatment of large symptomatic colon lipomas: A systematic review of efficacy and safety. United European Gastroenterol J 2020; 8:1147-1154. [PMID: 32746773 DOI: 10.1177/2050640620948661] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Various techniques have been described for endoscopic resection of large symptomatic colon lipomas. Lipoma unroofing might provide a safer, more time efficient and easier technique compared to dissection-based techniques, endoscopic mucosal resection (EMR) or loop-assisted resection. The aim of this systematic review was to compare efficacy and safety (endoscopic resolution rates, clinical remission rates and adverse events) of lipoma unroofing with respect to dissection-based techniques, EMR or loop-assisted resection. METHODS 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 efficacy and safety were compared. RESULTS Twenty four studies met the selection criteria, which encompassed 77 lesions (46.8% female, mean age 63 years (interquartile range (IQR) 53-72 years), mean size 45.4 mm (IQR 30.0-60.0 mm). Ten patients underwent unroofing (13.0%), whereas 7 (9.1%), 31 (40.3%) and 29 patients (37.7%) underwent dissection-based techniques, EMR and loop-assisted-snare resection, respectively. Endoscopic resolution rates were 60%, 100% (p = 0.103), 93.6% (p = 0.024) and 93.1% (p = 0.028). Clinical remission rates were identical in all four groups (100%). Amongst patients who underwent EMR and loop-assisted techniques, adverse events were identified in 12.9% (p = 0.556) and 13.8% (p = 0.556), respectively, compared to none in the unroofing and dissection-based resection group. CONCLUSIONS In patients with large colon lipomas, endoscopic treatment by unroofing, dissection-based resection, EMR and loop-assisted resection provided similar clinical remission rates. Amongst patients undergoing EMR and loop-assisted resection, increased endoscopic resolution rates were seen at the expense of more adverse events, although the latter did not reach statistical significance. Until more reliable comparative data are available, the most optimal resection technique should rely on local expertise and patient profile.
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Affiliation(s)
- Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospitals, Leuven, Belgium
| | | | - Peter Bossuyt
- Department of Gastroenterology and Hepatology, University Hospitals, Leuven, Belgium.,Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium
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20
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Mir AS, Kesar V, Sageer M, Grider D, Chitnavis V. Bleeding Gastric Lipoma Resected by Endoscopic Submucosal Dissection. Cureus 2020; 12:e8909. [PMID: 32742875 PMCID: PMC7389887 DOI: 10.7759/cureus.8909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Gastric lipomas are slow-growing benign lesions of the stomach that are often detected incidentally. Most cases are asymptomatic but larger lesions may become symptomatic, thereby requiring treatment. Multiple endoscopic modalities have been used for resection in the past. We present the case of a 67-year-old patient who presented with upper GI bleeding secondary to a gastric lipoma, which was successfully resected by endoscopic submucosal dissection.
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Affiliation(s)
- Adil S Mir
- Internal Medicine, Carilion Clinic, Roanoke, USA
| | - Varun Kesar
- Gastroenterology, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | - Mohamed Sageer
- Gastroenterology and Hepatology, Veterans Affairs Medical Center, Salem, USA.,Medicine/Gastroenterology, Virginia Tech, Roanoke, USA
| | - Douglas Grider
- Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, USA.,Pathology, Carilion Roanoke Memorial Hospital, Roanoke, USA
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21
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Sabbah M, Nakhli A, Helal I, Bellil N, Ouakaa A, Gargouri D. Gastrointestinal bleeding as an initial manifestation of gastric lipoma: Case report and review of the literature. Clin Case Rep 2020; 8:1988-1992. [PMID: 33088535 PMCID: PMC7562860 DOI: 10.1002/ccr3.3050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/01/2020] [Accepted: 05/28/2020] [Indexed: 12/22/2022] Open
Abstract
Gastric lipoma should be considered as a rare differential diagnosis in patients presenting with gastrointestinal bleeding. Diagnosis is mainly done by radiologic and endoscopic findings. It presents characteristic pathognomonic endoscopic signs.
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Affiliation(s)
- Meriam Sabbah
- Department of Gastroenterology Habib Thameur Hospital Tunis Tunisia.,Faculty of Medicine of Tunis University of Tunis El Manar Tunisia
| | - Abdelwahab Nakhli
- Department of Gastroenterology Habib Thameur Hospital Tunis Tunisia.,Faculty of Medicine of Tunis University of Tunis El Manar Tunisia
| | - Imen Helal
- Faculty of Medicine of Tunis University of Tunis El Manar Tunisia.,Department of Pathology Habib Thameur Hospital Tunis Tunisia
| | - Nawel Bellil
- Department of Gastroenterology Habib Thameur Hospital Tunis Tunisia.,Faculty of Medicine of Tunis University of Tunis El Manar Tunisia
| | - Asma Ouakaa
- Department of Gastroenterology Habib Thameur Hospital Tunis Tunisia.,Faculty of Medicine of Tunis University of Tunis El Manar Tunisia
| | - Dalila Gargouri
- Department of Gastroenterology Habib Thameur Hospital Tunis Tunisia.,Faculty of Medicine of Tunis University of Tunis El Manar Tunisia
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22
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Endoscopic Treatment of Intussusception From Massive Colonic Lipomas via Endoscopic Mucosal Resection: A Case Series. ACG Case Rep J 2019; 6:e00177. [PMID: 31750367 PMCID: PMC6831141 DOI: 10.14309/crj.0000000000000177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/17/2019] [Indexed: 11/17/2022] Open
Abstract
Although the safety and effectiveness of endoscopic resection of colonic lipomas has already been described, the ideal excisional technique continues to be debated. Notably, a majority of the proposed techniques focus on small, incidentally found lipomas. We report 3 patients with massive (≥8 cm) colonic lipomas presenting as intussusception that were successfully treated by piecemeal endoscopic mucosal resection. We propose endoscopic mucosal resection as the endoscopic treatment of choice and feasible alternative to surgery for the management of intussuscepting lipomas.
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23
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Fernandes J, Ramos R, Vicente C, Teles T, Canena J, Lopes L, Casteleiro C. Giant Lipoma Causing Intestinal Subocclusion: Detachable Snare Loop-Assisted Polypectomy. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2019; 26:293-294. [PMID: 31328146 DOI: 10.1159/000492067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/04/2018] [Indexed: 11/19/2022]
Affiliation(s)
- João Fernandes
- Gastroenterology Department, Centro Hospitalar Cova da Beira EPE, Covilhã, Portugal
| | - Rui Ramos
- Gastroenterology Department, Centro Hospitalar Cova da Beira EPE, Covilhã, Portugal
| | - Célia Vicente
- Gastroenterology Department, Centro Hospitalar Cova da Beira EPE, Covilhã, Portugal
| | - Tobias Teles
- Surgery Department, Centro Hospitalar Cova da Beira EPE, Covilhã, Portugal
| | - Jorge Canena
- Gastroenterology Department, Nova Medical School/Faculdade de Ciências Médicas de Lisboa, Lisbon, Portugal
| | - Luís Lopes
- Gastroenterology Department, Hospital Santa Luzia, Viana do Castelo, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Carlos Casteleiro
- Gastroenterology Department, Centro Hospitalar Cova da Beira EPE, Covilhã, Portugal
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24
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Affiliation(s)
- Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
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25
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Sullivan IW, Hota P, Dass C. Gastric lipomas: a case series and review of a rare tumor. BJR Case Rep 2019; 5:20180109. [PMID: 31501708 PMCID: PMC6726183 DOI: 10.1259/bjrcr.20180109] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/07/2018] [Accepted: 12/12/2018] [Indexed: 12/17/2022] Open
Abstract
The purpose of the study was to investigate and review the multimodality imaging findings of gastric lipomas. Seven patients with gastric lipomas identified by CT imaging at a single institution between 2003 and 2017 were retrospectively evaluated. Patient demographics, clinical presentation, non-invasive imaging, endoscopic, and pathological findings were recorded.The most common location for gastric lipoma was the gastric antrum (3/7). The mean lipoma size was 2.7 cm ± 0.8 cm. Six out of seven lipomas demonstrated homogenous fat attenuation with mean Hounsfield units (HU) between -80 and -120. A single lipoma measuring -50 HU demonstrated soft tissue septations. In addition to routine CT and MRI, gastric lipomas were diagnosed on the low-dose CT protocols such as coronary calcium scoring, renal stone, and positron emission tomography-CT (PET-CT). Our CT findings corroborate those reported previously. Soft tissue septations visualized in one lesion likely represented post-biopsy changes, adding this etiology to a differential which previously included only ulceration. Cases characterized by MRI are rare in the literature, and our study provides one such example. To our knowledge this study represents the first documentation of gastric lipomas on PET-CT and other low-dose CT imaging protocols.
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Affiliation(s)
- Ian W Sullivan
- Department of Radiology, Temple University
Hospital, Philadelphia, PA, USA
| | | | - Chandra Dass
- Department of Radiology, Temple University
Hospital, Philadelphia, PA, USA
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26
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Novel surgical approach without bowel resection for multiple gastrointestinal lipomatosis: A case report. Int J Surg Case Rep 2019; 59:54-57. [PMID: 31103954 PMCID: PMC6599446 DOI: 10.1016/j.ijscr.2019.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 05/02/2019] [Indexed: 01/17/2023] Open
Abstract
We experienced GI lipomatosis existing from the duodenum to the small intestine. In case of multiple lipomas, resection procedure and range cannot be determined. Intestinal lipomas were resected with local excision without any bowel resection. And duodenal lipoma was resected with ESD. Local excision + ESD seemed to be one of the methods in resecting lipomatosis.
Introduction Asymptomatic lipoma only requires observation, whereas symptomatic lipoma requires treatment such as endoscopic or surgical resection. However, in case of multiple lipomas, with evident diffusion and malignancy, resection procedure and range cannot be determined. We experienced GI lipomatosis (multiple lipomas) diffusely existing from the duodenum to the small intestine and involved recurrent intussusception. Presentation of case 47 year-old female was a history of open bowel resection for intestinal obstruction caused by intussusceptions of multiple small intestinal lipoma 11 years ago. EGD showed duodenal lipoma, and CT showed diffuse multiple lipomas from the proximal jejunum to the distal ileum. Another CT also showed intussusception of small intestine, but no signs of intestinal obstruction. Surgical procedures performed included diagnostic laparoscopy. All intestinal lipomas were resected with local excision, and duodenal lipoma was resected with ESD without any bowel resection. Discussion Multiple local excision ESD for multiple GI lipomatosis have not been reported. The most problematic thing is that if extensive resection is performed to cut off all multiple lipoma, short bowel syndrome may occur. Determining the range to be cut remains unclear. Conclusions Multiple local excision ± ESD seemed to be one of the methods in resecting multiple GI lipomatosis. In the future, cases and indications of surgery and resection method for GI lipoma should be accumulated and considered, respectively.
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27
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Mavrogenis G, Bazerbachi F, Tsevgas I, Zachariadis D. Endoscopic submucosal dissection and submucosal tunneling endoscopic resection for obstructive lipomas of the foregut and hindgut. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2019; 4:226-229. [PMID: 31061945 PMCID: PMC6493476 DOI: 10.1016/j.vgie.2019.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | - Fateh Bazerbachi
- Department of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ioannis Tsevgas
- Department of Gastroenterology, Mediterraneo Hospital, Athens, Greece
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28
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Donovan A, Abeyasundara S, Nabi H. Colonoscopic resection of giant colonic lipoma causing subacute large bowel obstruction. ANZ J Surg 2019; 90:E13-E14. [PMID: 30974488 DOI: 10.1111/ans.15082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/23/2018] [Accepted: 12/28/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Amy Donovan
- Department of Colorectal Surgery, Logan Hospital, Logan City, Queensland, Australia
| | - Sandun Abeyasundara
- Department of Colorectal Surgery, Logan Hospital, Logan City, Queensland, Australia
| | - Hajir Nabi
- Department of Colorectal Surgery, Logan Hospital, Logan City, Queensland, Australia
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29
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Affiliation(s)
- Shou-Jiang Tang
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Yehia M Naga
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
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30
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Cieszczyk K, Pasnik I, Wronecki L, Ostrowska A, Bojar P, Marzec-Kotarska B, Szumilo J. Gastric lipomatosis. CURRENT ISSUES IN PHARMACY AND MEDICAL SCIENCES 2018. [DOI: 10.1515/cipms-2018-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Gastric lipomatosis is a condition characterized by the presence of multiple lipomas or diffuse mature adipose tissue infiltration within the gastric wall. The diffuse form is thought to be an extremely rare, with only few described cases. The lesion may be asymptomatic or associated with symptoms and signs depending on location and size. Treatment depends on clinical presentation, range and complications. In a symptomatic disease, it should be surgical, but conservative treatment is preferred for asymptomatic and solitary lesions. Among diagnostic methods, computed tomography and magnetic resonance imaging are thought to be the most valuable.
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Affiliation(s)
- Katarzyna Cieszczyk
- Department of Clinical Pathomorphology , Medical University of Lublin , Jaczewskiego 8b, 20-090 Lublin , Poland
| | - Iwona Pasnik
- Department of Clinical Pathomorphology , Medical University of Lublin , Jaczewskiego 8b, 20-090 Lublin , Poland
| | - Lech Wronecki
- Department of Clinical Pathomorphology , Medical University of Lublin , Jaczewskiego 8b, 20-090 Lublin , Poland
| | - Anna Ostrowska
- Department of Clinical Pathomorphology , Medical University of Lublin , Jaczewskiego 8b, 20-090 Lublin , Poland
| | - Pawel Bojar
- Department of Clinical Pathomorphology , Medical University of Lublin , Jaczewskiego 8b, 20-090 Lublin , Poland
| | - Barbara Marzec-Kotarska
- Department of Clinical Pathomorphology , Medical University of Lublin , Jaczewskiego 8b, 20-090 Lublin , Poland
| | - Justyna Szumilo
- Department of Clinical Pathomorphology , Medical University of Lublin , Jaczewskiego 8b, 20-090 Lublin , Poland
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31
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Ingason AB, Theodors A, Agustsson AS, Arnarson A. Giant gastric lipoma successfully removed by endoscopic submucosal dissection: case report and systematic review. Scand J Gastroenterol 2018; 53:1018-1024. [PMID: 30134740 DOI: 10.1080/00365521.2018.1495259] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Gastric lipomas are rare adipose tumors that constitute less than 1% of gastric tumors. While lipomas generally do not need removal unless symptomatic, endoscopic resection has been proposed as safe for gastric lipomas smaller than 2 cm. Yet, there is no consensus on the optimal treatment method for larger lipomas. We report a case of a giant 7-cm gastric lipoma successfully removed by endoscopic submucosal dissection (ESD) and systematically review the literature for gastric lipomas removed by ESD. METHODS Systematic review was conducted by searching PubMed and Scopus databases, up to 15 February 2018, using combinations of relevant terms. RESULTS We report a 55-year-old male with known gastroesophageal reflux disease and asthma, who sought medical attention due to chronic heartburn and asthma exacerbations. These symptoms were attributed to a large 7 cm × 3 cm gastric lipoma that caused gastric outlet obstruction. The lipoma was safely removed by ESD, allowing quick recovery and alleviation of symptoms. In our review, we identified 20 gastric lipomas treated with ESD, with 15 (75%) being 2 cm or larger. The average size of the lipomas was 4 cm (range: 1.2-9 cm). All lipomas were limited to the submucosa, with 80% of the tumors located in the antrum. Three lipomas were removed by submucosal tunneling. All tumors were successfully removed en bloc and no major complications were reported. CONCLUSION Our findings support the conclusion that ESD may be a safe alternative to conventional surgery for removal of large symptomatic gastric lipomas.
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Affiliation(s)
- Arnar B Ingason
- a Department of Medicine , University of Iceland , Reykjavik , Iceland
| | - Asgeir Theodors
- b Department of Gastroenterology , Landspitali University Hospital , Reykjavik , Iceland
| | - Arnar S Agustsson
- a Department of Medicine , University of Iceland , Reykjavik , Iceland
| | - Adalsteinn Arnarson
- c Department of General Surgery , Landspitali University Hospital , Reykjavik , Iceland
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32
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Yagnik VD. Re: Gastric lipoma: a rare cause of gastrointestinal bleeding. ANZ J Surg 2018; 88:118. [PMID: 29392905 DOI: 10.1111/ans.14282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Vipul D Yagnik
- Department of Surgical Gastroenterology, Ronak Endo-Laparoscopy and General Surgical Hospital, Patan, India
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33
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Kumar P, Gray C. Response to Re: Gastric lipoma: a rare cause of gastrointestinal bleeding. ANZ J Surg 2018; 88:118-119. [PMID: 29392902 DOI: 10.1111/ans.14298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/11/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Prashant Kumar
- Department of Anaesthetics, Queen Elizabeth University Hospital, Glasgow, UK
| | - Chris Gray
- Department of General Surgery, Timaru Hospital, Timaru, New Zealand
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34
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Ichinose M, Hikichi T, Kanno Y, Gunji N, Fujita M, Kuroda M, Terashima K, Sato Y, Kawana S, Hashimoto Y, Ohira H, Miyata M. A case of gastric lipoma resected by endoscopic submucosa dissection with difficulty in preoperative diagnosis. Fukushima J Med Sci 2017; 63:160-164. [PMID: 28904301 DOI: 10.5387/fms.2016-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
A 66-year-old man was referred to our hospital with an increasing subepithelial lesion in the gastric antrum. Using esophagogastroduodenoscopy, a tumor with a steep, 20-mm-high rise protruding in the lumen was observed. The mucosal surface of the tumor was reddish, with ulcers forming at the base. Moreover, the tumor was mobile and soft. A biopsy specimen was taken from the ulcer, but tumor tissue was not collected from the submucosa. Endoscopic ultrasonography (EUS) showed a high echoic mass in the submucosa. However, because the mucosal surface of the ulceration was red, the mesenchymal tumor with internal bleeding was inferred to be lipoma. Additionally, because the tumor was small, flexible, and soft, collecting tumor tissue under EUS-guided fine-needle aspiration was inferred as difficult. We were unable to make a final diagnosis because the lesion showed a small tumor with atypical macroscopic morphology. Therefore, endoscopic submucosa dissection (ESD) was chosen for the diagnostic treatment. Sodium hyaluronate sufficient for separation from the muscular layer was injected into the submucosa. Then submucosal dissection was performed just above the muscle layer. Results demonstrate the possibility of removing the tumor reliably without perforation. Pathological evaluation of the ESD specimen indicated a diagnosis of gastric lipoma.
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Affiliation(s)
- Mizue Ichinose
- Department of Internal Medicine and Gastroenterology, Japanese Red Cross Fukushima Hospital
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima-City
| | - Yukiko Kanno
- Department of Internal Medicine and Gastroenterology, Japanese Red Cross Fukushima Hospital.,Department of Gastroenterology, Fukushima Medical University School of Medicine
| | - Naohiko Gunji
- Department of Internal Medicine and Gastroenterology, Japanese Red Cross Fukushima Hospital.,Department of Gastroenterology, Fukushima Medical University School of Medicine
| | - Masashi Fujita
- Department of Internal Medicine and Gastroenterology, Japanese Red Cross Fukushima Hospital.,Department of Gastroenterology, Fukushima Medical University School of Medicine
| | - Masahito Kuroda
- Department of Internal Medicine and Gastroenterology, Japanese Red Cross Fukushima Hospital
| | - Kumiko Terashima
- Department of Internal Medicine and Gastroenterology, Japanese Red Cross Fukushima Hospital
| | - Yoshinori Sato
- Department of Internal Medicine and Gastroenterology, Japanese Red Cross Fukushima Hospital
| | - Satoshi Kawana
- Department of Diagnostic Pathology, Fukushima Medical University School of Medicine
| | - Yuko Hashimoto
- Department of Diagnostic Pathology, Fukushima Medical University School of Medicine
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine
| | - Masayuki Miyata
- Department of Internal Medicine and Gastroenterology, Japanese Red Cross Fukushima Hospital
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35
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Lin JC, Chen PJ, Shih YL, Chang YM, Chang WK, Hsieh TY. A case of a large colonic lipoma resected by endoscopic submucosal dissection: A long-term endoscopic observation. ADVANCES IN DIGESTIVE MEDICINE 2017. [DOI: 10.1002/aid2.12114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Jung-Chun Lin
- Division of Gastroenterology; Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
- Graduate Institute of Medical Sciences; National Defense Medical Center; Taipei Taiwan
| | - Peng-Jen Chen
- Division of Gastroenterology; Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
- Graduate Institute of Medical Sciences; National Defense Medical Center; Taipei Taiwan
| | - Yu-Lueng Shih
- Division of Gastroenterology; Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
- Graduate Institute of Medical Sciences; National Defense Medical Center; Taipei Taiwan
| | - Yi-Ming Chang
- Department of Pathology; Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology; Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
- Graduate Institute of Medical Sciences; National Defense Medical Center; Taipei Taiwan
| | - Tsai-Yuan Hsieh
- Division of Gastroenterology; Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center; Taipei Taiwan
- Graduate Institute of Medical Sciences; National Defense Medical Center; Taipei Taiwan
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36
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Wu C, Yang JF, Tan Q, Zhang Q, Hu B. En bloc resection of a large symptomatic duodenal lipoma by endoscopic submucosal dissection. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2017; 2:182-184. [PMID: 29905299 PMCID: PMC5991501 DOI: 10.1016/j.vgie.2017.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Chuncheng Wu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Juliana F Yang
- Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Qinghua Tan
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiongying Zhang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
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Pei MW, Hu MR, Chen WB, Qin C. Diagnosis and Treatment of Duodenal Lipoma: A Systematic Review and a Case Report. J Clin Diagn Res 2017; 11:PE01-PE05. [PMID: 28892976 PMCID: PMC5583857 DOI: 10.7860/jcdr/2017/27748.10322] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/05/2017] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Duodenal lipoma is very rare with limited case reports present in literature. Owing to recent advances in endoscopy and modern imaging techniques, more cases are being diagnosed and treated. However, no systematic study of duodenal lipomas has been reported. AIM To study the diagnosis and treatment of duodenal lipoma in a female patient and review the relative literatures to enhance the knowledge of it. MATERIALS AND METHODS A literature search for 'duodenal lipoma' was performed on PubMed. Papers published from 1948 to 2016 in the English language were identified. Each article was then read in detail and analysed for clinical data, imaging features, diagnosis and therapy. Also, we hereby present a case of upper gastrointestinal obstruction secondary to multiple duodenal lipomas in a 67-year-old woman. The patient underwent a limited bowel resection with an uneventful recovery. RESULTS Literature review demonstrated 59 cases of duodenal lipoma, which indicate that duodenal lipomas are rare to occur but commonly found in the second part. The peak of incidence seems to be around the fifth and seventh decade of life. Duodenal lipomas may present as gastrointestinal bleeding, abdominal pain, obstruction or upper abdominal fullness. CT, MRI, Endoscopic Ultrasound (EUS), endoscopy are highly accurate diagnostic tools. The disease could be managed by endoscopy or surgery. CONCLUSION Our review of literature indicated duodenal lipoma is extremely rare. The symptoms are nonspecific and CT is the first choice for diagnosis. The treatment depends on the patient's condition as well as the size and position of the tumour.
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Affiliation(s)
- Mao Wei Pei
- Assistant Professor, Department of General Surgery, The Affiliated Hospital of Hangzhou Normal University, HangZhou, Zhejiang, China
| | - Ming Rong Hu
- Professor, Department of General Surgery, The Affiliated Hospital of Hangzhou Normal University, HangZhou, Zhejiang, China
| | - Wen Bin Chen
- Assistant Professor, Department of General Surgery, The Affiliated Hospital of Hangzhou Normal University, HangZhou, Zhejiang, China
| | - Chao Qin
- Assistant Professor, Department of General Surgery, The Affiliated Hospital of Hangzhou Normal University, HangZhou, Zhejiang, China
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Tomiki Y, Niwa K, Nagayasu K, Okazawa Y, Ito S, Ichikawa R, Ro H, Ishiyama S, Sugimoto K, Sakamoto K. Two Patients with Large Colonic Lipomas for which Endoscopic Unroofing was Ineffective. Case Rep Gastroenterol 2016; 10:538-544. [PMID: 27843431 PMCID: PMC5091224 DOI: 10.1159/000450542] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 08/31/2016] [Indexed: 12/18/2022] Open
Abstract
Endoscopic unroofing is effective for treating large colonic lipomas. However, additional endoscopic resection is occasionally required when the outcomes of initial unroofing are incomplete. The colonoscopy of an 82-year-old woman with abdominal pain revealed a yellowish lipoma of about 20 mm in the transverse colon. The mass was treated by unroofing, but a follow-up colonoscopy 5 days later revealed residual lipoma. One month later, the regenerated surface had become covered with mucosa, and the status of the lipoma had returned to that before unroofing. The colonoscopy of a 74-year-old man with abdominal pain and melena revealed a 50-mm-wide protruding lipoma in the transverse colon. The mucosa of the upper third of the lipoma was excised using an electric knife and snare, which allowed the immediate partial drainage of adipose tissue. Unroofing proceeded, but 7 days later, the unroofed surface had become coated with a white substance, and the residual lipoma required additional endoscopic resection. Colonic lipomas are often asymptomatic. However, patients with abdominal pain and hemorrhage should be treated in consideration of complete resection, but not by unroofing, which could leave a residual tumor. Drainage should be confirmed after unroofing and any residual lipoma should be treated by additional resection.
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Affiliation(s)
- Yuichi Tomiki
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Koichiro Niwa
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Kiichi Nagayasu
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yu Okazawa
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Shingo Ito
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Ryosuke Ichikawa
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Hisashi Ro
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Shun Ishiyama
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Kiichi Sugimoto
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Kazuhiro Sakamoto
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
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Affiliation(s)
- Diane Lorenzo
- Aix Marseille University, APHM, Hôpital Nord, Service de Gastroentérologie, Marseille, France
| | - Jean Michel Gonzalez
- Aix Marseille University, APHM, Hôpital Nord, Service de Gastroentérologie, Marseille, France
| | - Alban Benezech
- Aix Marseille University, APHM, Hôpital Nord, Service de Gastroentérologie, Marseille, France
| | - Marc Barthet
- Aix Marseille University, APHM, Hôpital Nord, Service de Gastroentérologie, Marseille, France
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40
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Bisschops R, Areia M, Coron E, Dobru D, Kaskas B, Kuvaev R, Pech O, Ragunath K, Weusten B, Familiari P, Domagk D, Valori R, Kaminski MF, Spada C, Bretthauer M, Bennett C, Senore C, Dinis-Ribeiro M, Rutter MD. Performance measures for upper gastrointestinal endoscopy: A European Society of Gastrointestinal Endoscopy quality improvement initiative. United European Gastroenterol J 2016; 4:629-656. [PMID: 27733906 DOI: 10.1177/2050640616664843] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 07/22/2016] [Indexed: 12/14/2022] Open
Affiliation(s)
- Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospital Leuven, Leuven, Belgium
| | - Miguel Areia
- Gastroenterology Department, Portuguese Oncology Institute, Coimbra, Portugal; Center for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal
| | - Emmanuel Coron
- Institut des Maladies de l'Appareil Digestif, CHU de Nantes, Nantes, France
| | - Daniela Dobru
- Gastroenterology Department, University of Medicine and Pharmacy, Targu Mures, Romania
| | - Bernd Kaskas
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Roman Kuvaev
- Endoscopy, Yaroslavl Regional Cancer Hospital, Yaroslavl, Russian Federation
| | - Oliver Pech
- Klinik für Gastroenterologie und interventionelle Endoskopie, Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Krish Ragunath
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust, Queen's Medical Centre Campus, Nottingham, UK
| | - Bas Weusten
- Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Pietro Familiari
- Digestive Endoscopy Unit, Agostino Gemelli University Hospital, Rome, Italy
| | - Dirk Domagk
- Department of Internal Medicine, Joseph's Hospital, Warendorf, Germany
| | - Roland Valori
- Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, UK
| | - Michal F Kaminski
- Department of Health Management and Health Economy and KG Jebsen Centre for Colorectal Cancer, University of Oslo, Oslo, Norway; Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, and Medical Center for Postgraduate Education, Warsaw, Poland
| | - Cristiano Spada
- Digestive Endoscopy Unit, Agostino Gemelli University Hospital, Rome, Italy
| | - Michael Bretthauer
- Department of Health Management and Health Economy and KG Jebsen Centre for Colorectal Cancer, University of Oslo, Oslo, Norway; Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Cathy Bennett
- Centre for Technology Enabled Research, Coventry University, Coventry, UK
| | - Carlo Senore
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy
| | - Mário Dinis-Ribeiro
- Center for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal; Servicio de Gastroenterologia, Instituto Portugues de Oncologia Francisco Gentil, Porto, Portugal
| | - Matthew D Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK; School of Medicine, Durham University, Durham, UK
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Yatagai N, Ueyama H, Shibuya T, Haga K, Takahashi M, Nomura O, Sakamoto N, Osada T, Yao T, Watanabe S. Obscure gastrointestinal bleeding caused by small intestinal lipoma: a case report. J Med Case Rep 2016; 10:226. [PMID: 27520963 PMCID: PMC4983028 DOI: 10.1186/s13256-016-1014-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 07/24/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Small intestinal lipomas are rare, usually asymptomatic, and most commonly encountered incidentally during investigation of the gastrointestinal tract for another reason. However, they may cause obscure gastrointestinal bleeding. CASE PRESENTATION We report a case of obscure gastrointestinal bleeding due to a small intestinal lipoma. A 69-year-old Japanese man on antiplatelet therapy presented to our department with tarry stools and anemic symptoms. A small intestinal tumor was detected by capsule endoscopy and double-balloon endoscopy. After laparoscopic resection, the tumor was confirmed to be a lipoma. CONCLUSIONS Small intestinal lipomas are difficult to detect by conventional modalities, but capsule endoscopy and double-balloon endoscopy are good modalities for the diagnosis of small intestinal lipomas. Treatment of small intestinal lipomas should be selected carefully, considering the tumor size, size of stalk, administration of antithrombotic therapy, and endoscopic operability.
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Affiliation(s)
- Noboru Yatagai
- Department of Gastroenterology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Hiroya Ueyama
- Department of Gastroenterology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan.
| | - Tomoyoshi Shibuya
- Department of Gastroenterology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Keiichi Haga
- Department of Gastroenterology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Masahito Takahashi
- Department of Gastroenterology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Osamu Nomura
- Department of Gastroenterology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Naoto Sakamoto
- Department of Gastroenterology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Taro Osada
- Department of Gastroenterology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Takashi Yao
- Department of Human Pathology, Juntendo University, School of Medicine, Tokyo, Japan
| | - Sumio Watanabe
- Department of Gastroenterology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
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Colonic Lipoma With Gastrointestinal Bleeding and Intussusception. ACG Case Rep J 2015; 2:135-6. [PMID: 26157941 PMCID: PMC4435409 DOI: 10.14309/crj.2015.32] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/14/2015] [Indexed: 11/17/2022] Open
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Kopáčová M, Rejchrt S, Bureš J. Unroofing Technique as an Option for the Endoscopic Treatment of Giant Gastrointestinal Lipomas. ACTA MEDICA (HRADEC KRÁLOVÉ) 2015; 58:115-8. [PMID: 26960822 DOI: 10.14712/18059694.2016.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Gastrointestinal lipomas are usually asymptomatic, detected incidentally. However, they can cause severe symptoms such as obstruction, invagination, and bleeding. The transsection of an infarcted or large lipoma by needle sphincterotome (needle knife) and/or snare polypectomy of the upper part of the tumour is an option for the endoscopy treatment of giant infarcted lipomas. Cutting a top of lipoma (unroofing technique) allowed flow out of adipose tissue from the lipoma.
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Affiliation(s)
- Marcela Kopáčová
- 2nd Department of Internal Medicine - Gastroenterology, Charles University in Prague, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové, Czech Republic.
| | - Stanislav Rejchrt
- 2nd Department of Internal Medicine - Gastroenterology, Charles University in Prague, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové, Czech Republic
| | - Jan Bureš
- 2nd Department of Internal Medicine - Gastroenterology, Charles University in Prague, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové, Czech Republic
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Aslan F, Akpinar Z, Cekic C, Alper E. En bloc resection of a 9 cm giant gastro-duodenal lipoma by endoscopic submucosal dissection. Dig Liver Dis 2015; 47:88-9. [PMID: 25304152 DOI: 10.1016/j.dld.2014.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 08/19/2014] [Accepted: 09/10/2014] [Indexed: 12/11/2022]
Affiliation(s)
- Fatih Aslan
- Gastroenterology, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey.
| | - Zehra Akpinar
- Gastroenterology, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey.
| | - Cem Cekic
- Gastroenterology, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey.
| | - Emrah Alper
- Gastroenterology, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey.
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45
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Lee CM, Kim HH. Minimally invasive surgery for submucosal (subepithelial) tumors of the stomach. World J Gastroenterol 2014; 20:13035-13043. [PMID: 25278697 PMCID: PMC4177482 DOI: 10.3748/wjg.v20.i36.13035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 03/12/2014] [Accepted: 05/29/2014] [Indexed: 02/07/2023] Open
Abstract
Minimally invasive surgery has become common in the surgical resection of gastrointestinal submucosal tumors (SMTs). The purpose of this article is to review recent trends in minimally invasive surgery for gastric SMTs. Although laparoscopic resection has been main stream of minimally invasive surgery for gastrointestinal SMTs, recent advances in endoscopic procedures now provide various treatment modalities for gastric SMTs. Moreover, investigators have developed several hybrid techniques that include the advantages of both laparoscopic and endoscopic procedure. In addition, several types of reduced port surgeries, modification of conventional laparoscopic procedures, have been recently applied to the surgical resection of SMTs. Meanwhile, robotic surgery for SMTs requires further evidence and improvement.
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