Walter Reed National Military Medical Center Bethesda, MD, United States
Cherry W. Huang, DO, Christina Steinhauser, DO, Allison M. Bush, MD, MPH, Jeffrey T. Laczek, MD, FACG Walter Reed National Military Medical Center, Bethesda, MD
Introduction: Gastrointestinal lipomas are rare, non-epithelial tumors arising from adipose tissue. The incidence of colonic lipomas ranges from 0.2 to 4.4% in autopsy series. The colon is the most common site of GI involvement by lipomas, accounting for 65 to 75%. Most colonic lipomas are clinically silent and are found incidentally during colonoscopy, imaging, surgery, or autopsy. If asymptomatic, these lipomas may not require treatment; however, large colonic lipomas can cause abdominal pain, intestinal obstruction, GI bleeding, and intussusception. Large or symptomatic lipomas require intervention to relieve symptoms or reduce risk of complications.
Case Description/Methods: We present a case series with 2 patients found to have enlarging colonic lipomas. One patient had a significant increase in the size of his lipoma on colonoscopies performed from unrelated reasons; the other patient presented with symptoms concerning for an intestinal obstruction. Both patients were treated with endoscopic unroofing of the lipoma. The top third of the lipoma was resected using hot snare electrocautery and the resected portion was retrieved. The remainder of the lipoma was left in place after unroofing to allow the remainder of the lipoma to be expelled as the mucosa scars down.
Discussion: Management for symptomatic colonic lipomas includes surgical resection or endoscopic options depending on the size and location of the lipoma. The optimal treatment route remains controversial, as the majority of lipomas do not require removal. Historically, endoscopic options were reserved for lesions less than 4cm due to the risk of bleeding and perforation for larger lesions. There are a few endoscopic techniques available including endoscopic mucosal resection, endoscopic submucosal dissection, and looping and ligating the lipoma with a detachable snare, otherwise known as “loop and let go.” Of the endoscopic techniques available, lipoma unroofing provides a safe, easy, less time-intensive alternative to other endoscopic choices that does not require any specialized equipment or advanced training.
Cherry Huang indicated no relevant financial relationships.
Christina Steinhauser indicated no relevant financial relationships.
Allison Bush indicated no relevant financial relationships.
Jeffrey Laczek indicated no relevant financial relationships.
Cherry W. Huang, DO, Christina Steinhauser, DO, Allison M. Bush, MD, MPH, Jeffrey T. Laczek, MD, FACG. P2534 - Just a Little off the Top: A Case Series of Endoscopically Unroofed Colonic Lipomas, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.