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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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Chen HY, Ning SB, Yin X, Li BR, Zhang J, Jin XW, Sun T, Xia ZB, Zhang XP. Balloon-assisted endoscopic submucosal dissection for treating small intestinal lipomas: Report of two cases. World J Clin Cases 2021; 9:1631-1638. [PMID: 33728306 PMCID: PMC7942049 DOI: 10.12998/wjcc.v9.i7.1631] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/21/2020] [Accepted: 01/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Most small intestinal lipomas are treated surgically, and some require repeated surgeries for multiple lipomas. However, application of endoscopic submucosal dissection (ESD) technology in the deep small intestine is rarely reported owing to the special anatomical structure of the small intestine, medical equipment limitations, and the lack of relevant experience among endoscopists.
CASE SUMMARY Two patients with small intestinal lipomas treated at the Air Force Medical Center from November 2015 to September 2019 were selected to undergo balloon-assisted ESD to treat the lipomas and explore the technical feasibility and safety of ESD for treating small intestinal lipomas. The two patients successfully underwent balloon-assisted ESD to treat four small intestinal lipomas, with a complete resection rate of 100% (4/4), without intraoperative or postoperative bleeding, perforation, or other complications. After 3-6 mo of postoperative follow-up, the clinical symptoms caused by the lipomas were significantly relieved or disappeared after treatment.
CONCLUSION Balloon-assisted ESD is a safe and reliable new method for treating deep intestinal lipomas and shows good clinical feasibility.
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Affiliation(s)
- Hong-Yu Chen
- Department of Gastroenterology, Air Force Medical Center, PLA of China, Beijing 100142, China
| | - Shou-Bin Ning
- Department of Gastroenterology, Air Force Medical Center, PLA of China, Beijing 100142, China
| | - Xin Yin
- Department of Gastroenterology, Air Force Medical Center, PLA of China, Beijing 100142, China
| | - Bai-Rong Li
- Department of Gastroenterology, Air Force Medical Center, PLA of China, Beijing 100142, China
| | - Jing Zhang
- Department of Gastroenterology, Air Force Medical Center, PLA of China, Beijing 100142, China
| | - Xiao-Wei Jin
- Department of Gastroenterology, Air Force Medical Center, PLA of China, Beijing 100142, China
| | - Tao Sun
- Department of Gastroenterology, Air Force Medical Center, PLA of China, Beijing 100142, China
| | - Zhi-Bo Xia
- Department of Gastroenterology, Air Force Medical Center, PLA of China, Beijing 100142, China
| | - Xiao-Peng Zhang
- Department of Gastroenterology, Air Force Medical Center, PLA of China, Beijing 100142, China
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Pei M, Hu M, Chen W, Qin C. Multiple Duodenal Lipomas as a Rare Cause of Upper Gastrointestinal Obstruction: Case Report and Literature Review. Gastroenterology Res 2017; 10:149-152. [PMID: 28496542 PMCID: PMC5412554 DOI: 10.14740/gr817w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2017] [Indexed: 12/23/2022] Open
Abstract
Duodenal lipomas are rare benign tumors and pose a diagnostic challenge as their symptoms are non-specific. In this article, we reported a case of duodenal lipoma presenting as upper gastrointestinal obstruction and reviewed the literature on relevant clinical manifestation, diagnosis and treatment. Our review of literature indicated that multiple duodenal lipomas as a cause of upper gastrointestinal obstruction as reported here are extremely rare. The preoperative computed tomography and magnetic resonance imaging are the key to diagnosis, and surgical resection is the most effective means for the management of such duodenal lipomas.
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Affiliation(s)
- Maowei Pei
- Department of General Surgery, Hangzhou Normal University Affiliated Hospital, Hangzhou, China
| | - Mingrong Hu
- Department of General Surgery, Hangzhou Normal University Affiliated Hospital, Hangzhou, China
| | - Wenbin Chen
- Department of General Surgery, Hangzhou Normal University Affiliated Hospital, Hangzhou, China
| | - Chao Qin
- Department of General Surgery, Hangzhou Normal University Affiliated Hospital, Hangzhou, China
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Kida A, Matsuda K, Matsuda M, Sakai A, Noda Y. A unique case of massive gastrointestinal bleeding. SAGE Open Med Case Rep 2017; 5:2050313X17700345. [PMID: 28540052 PMCID: PMC5433657 DOI: 10.1177/2050313x17700345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 02/21/2017] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Lipomas are the second most common benign tumors of the small bowel, and most lipomas are asymptomatic. However, lipomas with diameters of >20 mm tend to be symptomatic, for example, to cause bleeding, obstructive jaundice, abdominal pain, intestinal obstruction, intussusception, and/or perforation. METHODS/RESULTS We report a case of massive gastrointestinal bleeding from a jejunal lipoma combined with intussusception. A preoperative diagnosis of gastrointestinal bleeding derived from a jejunal lipoma combined with intussusception was made based on double-balloon enteroscopy and contrast-enhanced computed tomography, and partial resection of the small intestine was performed. After surgery, there was no additional gastrointestinal bleeding. CONCLUSION There have only been a few reports about cases of jejunal lipoma involving simultaneous bleeding and intussusception. Double-balloon enteroscopy is useful for preoperatively diagnosing bleeding from a lipoma. Our case highlights that jejunal lipoma can cause massive unexplained gastrointestinal bleeding.
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Affiliation(s)
- Akihiko Kida
- Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama City, Japan
| | - Koichiro Matsuda
- Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama City, Japan
| | - Mitsuru Matsuda
- Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama City, Japan
| | - Akito Sakai
- Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama City, Japan
| | - Yatsugi Noda
- Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama City, 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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Ponte A, Pinho R, Rodrigues A, Vale S, Cidade C, Silva J, Rodrigues J, Sousa M, Carvalho J. Endoscopic resection of large gastrointestinal lipomas: Loop-and-let-go technique with some twists. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 40:465-467. [PMID: 27480823 DOI: 10.1016/j.gastrohep.2016.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/09/2016] [Accepted: 06/01/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Ana Ponte
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal.
| | - Rolando Pinho
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal
| | - Adélia Rodrigues
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal
| | - Sílvio Vale
- Department of General Surgery, Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal
| | - Cassilda Cidade
- Department of General Surgery, Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal
| | - Joana Silva
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal
| | - Jaime Rodrigues
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal
| | - Mafalda Sousa
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal
| | - João Carvalho
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal
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Zirpe D, Wani M, Tiwari P, Ramaswamy PK, Kumar RP. Duodenal Lipomatosis as a Curious Cause of Upper Gastrointestinal Bleed: A Report with Review of Literature. J Clin Diagn Res 2016; 10:PE01-4. [PMID: 27437304 DOI: 10.7860/jcdr/2016/19851.7881] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/15/2016] [Indexed: 12/17/2022]
Abstract
Lipomas of the gastrointestinal tract are rare. Duodenal lipomas are incidental and mostly asymptomatic. Tumours may produce symptoms of abdominal pain and discomfort or cause bleeding due to ulceration or intestinal obstruction due to intussusception. We describe a 45-year-old man presenting in emergency with 3 days history of melena with normal gastroduodenoscopy and contrast enhanced computed tomography revealing multiple polypoid lesion in duodenum and proximal jejunum suggestive of lipoma. Due to ongoing bleed, he underwent laparotomy with duodenectomy and uneventful postoperative recovery. Our review of cases published in last 67 years indicate that duodenal lipomas are rare to occur but commonly found in second part, they may be seen in third and fourth part of duodenum which may be missed on endoscopy. They can be multiple and may present as severe UGI bleeding which could be managed surgically. Though CT is diagnostic, histopathology confirms the diagnosis which shows lipomatous lesion composed of mature adipose arranged in lobules.
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Affiliation(s)
- Dinesh Zirpe
- Senior Registrar, Department of Surgical Gastroenterology and Minimal Access Surgery, Apollo Hospitals (Main) , Greams Road, Chennai, Tamilnadu, India
| | - Majid Wani
- Senior Registrar, Department of Surgical Gastroenterology and Minimal Access Surgery, Apollo Hospitals (Main) , Greams Road, Chennai, Tamilnadu, India
| | - Priyanka Tiwari
- Senior Registrar, Department of Surgical Gastroenterology and Minimal Access Surgery, Apollo Hospitals (Main) , Greams Road, Chennai, Tamilnadu, India
| | | | - Reddy Prasanna Kumar
- Senior Consultant, Department of Surgical Gastroenterology and Minimal Access Surgery, Apollo Hospitals (Main) , Greams Road, Chennai, Tamilnadu, India
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Chou JW, Cheng KS, Lin CP. A large symptomatic jejunal subepithelial tumor treated with endoloop-assisted polypectomy using spiral enteroscopy. Intest Res 2016; 14:104-5. [PMID: 26884743 PMCID: PMC4754515 DOI: 10.5217/ir.2016.14.1.104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 12/11/2015] [Accepted: 12/12/2015] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jen-Wei Chou
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, China Medical University Hospital, College of Medicine, China Medical University, Taichung, Taiwan, Republic of China.; Taiwan Society of Inflammatory Bowel Disease, Taiwan, Republic of China.; Taiwan Association for the Study of Small Intestinal Diseases, Taiwan, Republic of China
| | - Ken-Sheng Cheng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, China Medical University Hospital, College of Medicine, China Medical University, Taichung, Taiwan, Republic of China
| | - Ching-Pin Lin
- Division of Gastroenterology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China.; Taiwan Society of Inflammatory Bowel Disease, Taiwan, Republic of China.; Taiwan Association for the Study of Small Intestinal Diseases, Taiwan, Republic of China
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9
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Lipoma of the small intestine treated with endoscopic resection. Clin J Gastroenterol 2014; 7:502-5. [PMID: 25414085 DOI: 10.1007/s12328-014-0538-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 11/03/2014] [Indexed: 12/16/2022]
Abstract
We report a case of lipoma of the small intestine that was treated by endoscopic resection. A 79-year-old man who complained of tarry stool was diagnosed as having jejunal tumor at a neighboring clinic. Computed tomography (CT) and enteroscopy demonstrated an ulcerating jejunal mass. Because the tumor was considered to be the source of bleeding, we removed it under double-balloon endoscopy with a SB knife without any procedure-related complications. Histological examination revealed that the tumor was composed of mature adipose tissue, compatible with lipoma. SB knife, a scissors-type device for submucosal dissection, may be more appropriate than snare polypectomy for removal of small bowel tumors, because it can control bleeding readily and satisfactorily. Our experience suggests that submucosal dissection may be an appropriate procedure for removal of lipomas of the intestine. Endoscopic resection with SB knife and double-balloon endoscopy is a potential option to avoid surgical resection in the management of tumors of the small intestine.
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10
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Yaman İ, Derici H, Paksoy S. Symptomatic duodenal lipoma with endoscopic snare polypectomy. ULUSAL CERRAHI DERGISI 2014; 30:103-5. [PMID: 25931905 DOI: 10.5152/ucd.2014.2069] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 07/19/2013] [Indexed: 11/22/2022]
Abstract
Duodenal lipomas are extremely rare benign tumors. 90% arise from the submucosa and is usually localized in the second portion. They are usually asymptomatic and are detected incidentally during endoscopy or surgery. Appearance of symptoms are related to lesion size, those greater than four centimeters frequently may cause intussusception, obstruction or bleeding. A 59- year-old woman presented with complaints of abdominal fullness in the upper quadrants after meals, and heartburn symptoms. She had been under treatment for iron deficiency anemia during the last five months. The upper gastrointestinal endoscopy revealed a mobile, 4×2 cm polypoid mass extending from the second portion of the duodenum to the third portion, with a regular mucosa and wide pedicle. Saline and epinephrine was injected to polyp base and "snare" polypectomy was performed. Patient's complaint of fullness in the upper part of the abdomen declined after polypectomy and the treatment of anemia was discontinued after a month, with normal blood count values in the fourth month.
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Affiliation(s)
- İsmail Yaman
- Department of General Surgery, Balıkesir University Faculty of Medicine, Balıkesir, Turkey
| | - Hayrullah Derici
- Department of General Surgery, Balıkesir University Faculty of Medicine, Balıkesir, Turkey
| | - Serpil Paksoy
- Department of Pathology, Balıkesir University Faculty of Medicine, Balıkesir, Turkey
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11
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Suck-ligate-unroof-biopsy by using a detachable 20-mm loop for the diagnosis and therapy of small subepithelial tumors (with video). Gastrointest Endosc 2014; 79:750-5. [PMID: 24238309 DOI: 10.1016/j.gie.2013.09.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 09/30/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND The diagnosis and therapy of subepithelial tumors (SETs) can be challenging. OBJECTIVE Proof-of-concept evaluation of the suck-ligate-unroof-biopsy (SLUB) technique for small (<2 cm), non-pedunculated SETs. DESIGN Pilot feasibility study. SETTING Tertiary-care referral center. PATIENTS Twenty-three patients (median age 60 years) meeting the inclusion criteria after preliminary EUS. INTERVENTION SET ligation was performed with a detachable 20-mm loop deployed through an 18-mm diameter, soft, oblique, transparent, cap attachment. The SLUB technique comprised (1) suction to draw the SET into the cap; (2) ligation below the SET, confirmation by repeat EUS; (3) unroofing of the overlying mucosa with a needle-knife; and (4) biopsy specimens taken from the exposed tumor. MAIN OUTCOME MEASUREMENTS Technical success, histology and/or immunohistochemistry yield, adverse events, completeness of resection. RESULTS SLUB was attempted on 24 SETs and was technically successful in all. Location was the stomach (n = 19), small bowel (n = 1), colon (n = 2), and rectum (n = 2). Median size by EUS was 10 mm (range 6-15 mm). Biopsy specimens provided an immunohistologic diagnosis in all cases: GI stromal tumor (n = 5), leiomyoma (n = 8), carcinoid tumor (n = 5), Vanek's tumor (n = 2), granuloma (n =1), and pancreatic heterotopia (n = 3). Follow-up endoscopy and EUS in 13 patients showed well-healed scars with no residual tumor, including all 9 patients with premalignant neoplastic lesions. The only adverse event was self-limited pain in 2 patients. LIMITATIONS Single center, single operator, small sample size. CONCLUSIONS Loop ligation of small, non-pedunculated SETs is feasible by using a cap attachment for suction. Unroofing after ligation is safe and provides sufficient tissue for immunohistochemistry. Ligation combined with unroofing appears to lead to complete ablation by ischemia and tumor enucleation.
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12
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Matsushita M, Fukata N, Okazaki K. Endoscopic removal of large gastric lipomas: en bloc resection with submucosal dissection or partial resection with unroofing technique? Dig Endosc 2013; 25:211-2. [PMID: 23368769 DOI: 10.1111/den.12011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
| | - Norimasa Fukata
- Third Department of Internal Medicine; Kansai Medical University; Osaka; Japan
| | - Kazuichi Okazaki
- Third Department of Internal Medicine; Kansai Medical University; Osaka; Japan
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Sugimoto K, Sato K, Maekawa H, Sakurada M, Orita H, Ito T, Saita M, Ikota M, Yoshida Y, Yamano M. Unroofing technique for endoscopic resection of a large colonic lipoma. Case Rep Gastroenterol 2012; 6:557-62. [PMID: 22949897 PMCID: PMC3432998 DOI: 10.1159/000342350] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A 77-year-old man presented with repeated episodes of melena. He had a medical history of hypertension, atrial fibrillation and cardiogenic brain infarction and took medications, i.e. an antiplatelet agent. Laboratory data revealed iron deficiency anemia. Colonoscopy revealed a yellowish smooth submucosal tumor, 50 mm in diameter, on the Bauhin valve. The lesion was soft and compressible. The overlying mucosa was erosive. CT scan showed a uniform mass with very low density in the ascending colon, corresponding to the above-detected lesion. The clinical diagnosis of colonic lipoma was established. Using a 25 mm electrocautery snare (Olympus, Tokyo, Japan), we transected the upper portion of the mass to unroof the lesion. The mucosa layer was thick and hard. Fat tissue was observed extruding from the cut surface, consistent with the diagnostic hypothesis. After dissecting the overlying mucosa on the anal side by means of an IT knife (Olympus) in order to completely extrude the mass, the fat tissue was further exposed. It took about 26 min to perform the whole procedure. There were no procedure-related complications. Macroscopically, the resected lesion was a yellow solid tumor, 1.6 × 1.5 × 0.7 cm in diameter. Histopathologic examination of the excised specimen confirmed the diagnosis of a lipoma. The clinical course was uneventful. A follow-up endoscopy 1 month later showed a scarred mucosa at the resection site. Similarly, a follow-up CT scan 2 months later revealed no evidence of residual lipoma. The unroofing technique is safe, easy and suitable for the treatment of large lipomas.
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Affiliation(s)
- Kiichi Sugimoto
- Department of Surgery, Juntendo University Shizuoka Hospital, Izunokuni, Japan
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Efe C, Purnak T, Ozaslan E, Kücükciloglu Y. Which is the best approach for the hemorrhagic duodenal lipoma: endoscopic resection or surgery? Am J Surg 2011; 203:558. [PMID: 21803327 DOI: 10.1016/j.amjsurg.2010.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 08/12/2010] [Indexed: 11/18/2022]
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Kadaba R, Bowers KA, Wijesuriya N, Preston SL, Bray GB, Kocher HM. An unusual cause of gastrointestinal bleeding: duodenal lipoma. Case Rep Gastroenterol 2011; 5:183-8. [PMID: 21552442 PMCID: PMC3088745 DOI: 10.1159/000327219] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Common causes of chronic upper gastrointestinal bleeding include oesophageal varices, gastroduodenal ulcers and malignancy, and patients mostly present with iron deficiency type anaemia. We present the case of a 60-year-old lady who presented with iron deficiency anaemia and on investigation was found to have a large duodenal polyp requiring surgical excision. On histological examination, the polyp was revealed to be a lipoma. We review the recent literature and formulate a management plan for this rare entity.
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Affiliation(s)
- R Kadaba
- Barts and The London HPB Centre, The Royal London Hospital, London, UK
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Huang WH, Feng CL, Lai HC, Yu CJ, Chou JW, Peng CY, Yang MD, Chiang IP. Endoscopic ligation and resection for the treatment of small EUS-suspected gastric GI stromal tumors. Gastrointest Endosc 2010; 71:1076-81. [PMID: 20438899 DOI: 10.1016/j.gie.2009.12.041] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 12/30/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND GI stromal tumors (GISTs), with their potential for malignant transformation, are usually treated by surgical intervention. Endoscopic treatment remains controversial. OBJECTIVE The aim of this study was to investigate clinical outcomes associated with use of endoscopic ligation and resection for diagnosis and treatment of small EUS-suspected gastric GISTs. DESIGN Prospective case series. SETTING Academic medical center. PATIENTS Eight patients with submucosal gastric tumors <2 cm in diameter suspected to be GISTs. INTERVENTIONS Endoscopic ligation and resection. MAIN OUTCOME MEASUREMENTS Clinical/technical feasibility, success, and adverse events. RESULTS Seven patients with small EUS-suspected gastric GISTs were successfully treated by endoscopic ligation, with sloughing of residual tissue within 1 month. All were diagnosed pathologically with GISTs of low malignant potential. One additional patient required a second ligation to remove residual tumor, also diagnosed as a GIST with low malignant potential. No perforation, massive hemorrhage, or other complication requiring endoscopic or surgical intervention occurred. LIMITATIONS Small number of patients (n = 8) and limited follow-up; risk of microscopically positive margins, which limits application to lesions strongly suspected to be benign. CONCLUSIONS Endoscopic ligation and resection shows promise as a safe and feasible technique to treat small EUS-suspected gastric GISTs. Controlled clinical trials with more subjects and longer follow-up are needed to confirm the value and limitations of this method.
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Affiliation(s)
- Wen-Hsin Huang
- Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
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Morimoto T, Fu KI, Konuma H, Izumi Y, Matsuyama S, Ogura K, Miyazaki A, Watanabe S. Peeling a giant ileal lipoma with endoscopic unroofing and submucosal dissection. World J Gastroenterol 2010; 16:1676-9. [PMID: 20355250 PMCID: PMC2848380 DOI: 10.3748/wjg.v16.i13.1676] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Lipoma is relatively common in the colon but is less often in the small intestine. Most lipomas are incidentally detected at endoscopy and are usually small and asymptomatic. However, some of them can present with obstruction and/or intussusceptions. Surgical resection is commonly recommended to remove such significant lipomas with a limited pedicle and larger than 2 cm in size, as endoscopic resection may result in unfavorable complications such as intestinal perforations. We report a case of 62-year-old man presenting with hematochezia. Colonoscopy showed a submucosal tumor, about 50 mm in size, in the terminal ileum. A clinical diagnosis of lipoma was established based on the findings of colonoscopy and abdominal computed tomography (CT). As the patient complained of hematochezia and mild iron deficiency anemia associated with repeated tumor prolapse, we decided to remove his lipoma. Consequently, the lesion was completely removed en bloc. Although abdominal CT immediately after removal of the lesion showed a small amount of free air, conservative treatment was successfully carried out for the perforation. Histologically, the removed lesion was a lipoma.
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Lee CK, Chung IK, Lee SH, Lee SH, Lee TH, Park SH, Kim HS, Kim SJ, Cho HD. Endoscopic partial resection with the unroofing technique for reliable tissue diagnosis of upper GI subepithelial tumors originating from the muscularis propria on EUS (with video). Gastrointest Endosc 2010; 71:188-94. [PMID: 19879567 DOI: 10.1016/j.gie.2009.07.029] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2009] [Accepted: 07/19/2009] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is a growing body of evidence that a pathological diagnosis is necessary for small (<3 cm in diameter), asymptomatic, hypoechoic, subepithelial tumors (SETs) originating from the muscularis propria on EUS. However, the diagnostic efficacy of current tissue sampling techniques appears to be limited. OBJECTIVE To evaluate the diagnostic yield and safety of endoscopic partial resection using the unroofing technique (EPR-UT) in a subset of patients. DESIGN A prospective case series. SETTING A single tertiary-care referral center. PATIENTS Between August 2007 and March 2009, 16 patients with hypoechoic SETs of <3 cm in diameter, originating from the muscularis propria on EUS (14 gastric and 2 esophageal lesions), underwent EPR-UT. INTERVENTIONS The overlying mucosa was removed by using the unroofing technique using a conventional snare with electrical current to expose the tumor sufficiently. Next, the exposed tumor was partially resected by snaring. MAIN OUTCOME MEASUREMENTS The diagnostic yield and safety of this method. RESULTS EPR-UT provided specimens that were sufficient for a diagnosis and the assessment of risk for malignancy in 15 out of 16 cases (diagnostic yield 93.7% [95% CI, 80.4%-100.0%]). The pathological diagnoses were leiomyoma (7 of 15, 46.6%), GI stromal tumor (6 of 15, 40.0%), aberrant pancreas (1 of 15, 6.6%), and well-differentiated neuroendocrine carcinoma (1 of 15, 6.6%). Six cases with GI stromal tumor were classified as very low risk for malignant potential (mitotic index <5/50 high-power fields). Procedural blood oozing was relatively common (9 of 16, 56.0% [95% CI, 33.0%-77.0%]); however, this minor complication was easily controlled by argon plasma coagulation. There were no procedure-related major complications (0 of 16, 0% [95% CI, 0.0%-23.0%]). LIMITATIONS Single-center, noncomparative study with small sample size. CONCLUSION EPR-UT appears to be simple, safe, and effective for determining the definite pathological diagnosis and assessing malignant potential of small, hypoechoic SETs originating from the muscularis propria on EUS.
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Affiliation(s)
- Chang Kyun Lee
- Division of Gastroenterology, Department of Internal Medicine, Soon Chun Hyang University College of Medicine, Cheonan Hospital, Cheonan, Korea
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