Successful endoscopic treatment of colon lymphangioma with a ligating device

Cystic Lymphangioma of the Colon: Endoscopic Removal beyond the Frontiers of Size

Cystic lymphangiomas are benign colonic neoplasms arising from the submucosa. Traditionally, endoscopic resection has been described for smaller lesions, while surgery is reserved for larger symptomatic lesions. We present a case of a 69-year-old asymptomatic individual noted to have a cystic lymphangioma of the colon measuring 5 cm, which was successfully removed with endoloop endoscopic resection without any complications.

Cavernous, arteriovenous, and mixed hemangioma-lymphangioma of the rectosigmoid: rare causes of rectal bleeding--case series and review of the literature

INTRODUCTION

Cavernous hemangiomas of the sigmoid colon and rectum are uncommon vascular malformations usually found in young adults with a long history of episodic and painless rectal bleeding. Alternatively, they may present with massive life-threatening hemorrhage.

DISCUSSION

We report three cases of hemangioma of the rectosigmoid including one case of cavernous hemangioma, one case of arteriovenous hemangioma, and one case of hemangiolymphangiomatosis with emphasis on clinical presentation, radiologic, operative, and pathologic findings. Definitive treatment consists of complete resection with a sphincter-preserving procedure or abdominoperineal resection, based on extent of disease.

CONCLUSION

Therapy is typically delayed by several years in these patients due to erroneous diagnosis and failed treatment of hemorrhoids and inflammatory bowel disease. Relative to hemangiomas, lymphangiomas of the rectosigmoid are even more rare and when symptomatic, present with rectal bleeding and pelvic pain.

Endoloop ligation of large pedunculated submucosal tumors (with videos)

BACKGROUND

Endoscopic treatment of a pedunculated submucosal tumor (SMT) has not been well established. In particular, endoscopic cautery snare resection of a large pedunculated SMT is discouraged because of the increased risk of bowel perforation.

OBJECTIVE

To report the clinical outcome of endoloop ligation for the treatment of various pedunculated SMTs with a clip-marking technique.

DESIGN

Prospective evaluation of 10 patients who, between June 2005 and May 2006, received endoloop ligation with a clip-marking technique.

SETTING

At a tertiary-care, academic medical center.

PATIENTS

Ten patients with various pedunculated SMTs with either symptomatic lesions or large-sized lesions (>4 cm).

MAIN OUTCOME MEASUREMENTS

Clinical procedural success, reported adverse events.

RESULTS

Nine cases were successfully treated, with tumor removal within 4 weeks. In contrast, only 1 patient needed a second session of loop ligation. Only 6 specimens were retrieved. There were no procedure-related complications, such as bleeding or perforation.

LIMITATIONS

Retrieval by the patient of a specimen from stool was possible in only 60% of cases; a limited number of 10 patients; by oncology standards, not the correct treatment for nonlipomatous lesions, which limits its application to surgical risk candidates.

CONCLUSIONS

Endoloop ligation of large pedunculated SMTs seemed to be technically feasible and appeared to be safe in this case series. Further controlled clinical trials have to be conducted before application of this technique to a large submucosal lipoma or other SMTs in surgical high-risk candidates can be generally recommended.

Endoloop-assisted polypectomy for large pedunculated colorectal polyps

BACKGROUND

The use of an endoloop may minimize the risk for bleeding after endoscopic polypectomy of large colorectal polyps. This study aimed to assess the safety and efficacy of colonoscopic ligation of the stalk of large pedunculated polyps by means of an endoloop technique, and to focus particular attention on the instances in which the use of this device was unsuccessful.

METHODS

This study retrospectively evaluated attempted endoloop endoscopic polypectomy in 33 patients (19 men and 14 women; mean age, 62.5 years) with large pedunculated polyps.

RESULTS

Application of the endoloop was impossible in four patients, and the snare became entangled with the loop in one patient. The remaining 28 patients underwent endoloop-assisted polypectomy. Bleeding occurred in four patients, either because the loop slipped of the stalk after polypectomy (2 patients) or because a thin stalk (< or = 4 mm) was transected by the loop before polypectomy (2 patients).

CONCLUSION

Colonoscopic polypectomy with an endoloop may be safer than conventional polypectomy. The reasons for technical failure of this technique include a narrow left colon lumen, a thin stalk (< or = 4 mm), and close cutting in relation to the site of encirclement by the loop.

Cystic lymphangioma of the colon: endosonographic diagnosis with through-the-scope catheter miniprobe and determination of further management. Report of a case

Lymphangioma of the colon is rare. There are several reports that endoscopic ultrasound is useful for diagnosis of colonic lymphangioma. We report a case of lymphangioma of colon diagnosed by catheter endosonography and review the literature on endoscopic ultrasound in cystic lymphangioma of the gastrointestinal tract. A 70-year-old female was found to have two submucosal lesions in the colon by colonoscopy. Endoscopic ultrasound revealed that these lesions were anechoic, multicystic, and confined to the submucosa, and the underlying muscularis propria was intact. These findings were consistent with cystic lymphangioma. If typical endosonographic images of an anechoic, septated lesion within colonic submucosa are obtained, further workup or treatment may not be necessary if the patient is asymptomatic.