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Lu Q, Peng QZ, Yao J, Wang LS, Li DF. Ligation-assisted endoscopic submucosal resection following unroofing technique for small esophageal subepithelial lesions originating from the muscularis propria. World J Gastroenterol 2024; 30:3748-3754. [PMID: 39221067 PMCID: PMC11362874 DOI: 10.3748/wjg.v30.i32.3748] [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: 02/25/2024] [Revised: 07/19/2024] [Accepted: 08/09/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND The majority of esophageal subepithelial lesions originating from the muscularis propria (SEL-MPs) are benign in nature, although a subset may exhibit malignant characteristics. Conventional endoscopic resection techniques are time-consuming and lack efficacy for small SEL-MPs. AIM To evaluate the efficacy and safety of ligation-assisted endoscopic submucosal resection (ESMR-L) following unroofing technique for small esophageal SEL-MPs. METHODS From January 2021 to September 2023, 17 patients diagnosed with esophageal SEL-MPs underwent ESMR-L following unroofing technique at the endoscopy center of Shenzhen People's Hospital. Details of clinicopathological characteristics and clinical outcomes were collected and analyzed. RESULTS The mean age of the patients was 50.12 ± 12.65 years. The mean size of the tumors was 7.47 ± 2.83 mm and all cases achieved en bloc resection successfully. The average operation time was 12.2 minutes without any complications. Histopathology identified 2 Lesions (11.8%) as gastrointestinal stromal tumors at very low risk, 12 Lesions (70.6%) as leiomyoma and 3 Lesions (17.6%) as smooth muscle proliferation. No recurrence was found during the mean follow-up duration of 14.18 ± 9.62 months. CONCLUSION ESMR-L following roofing technique is an effective and safe technique for management of esophageal SEL-MPs smaller than 20 mm, but it cannot ensure en bloc resection and may require further treatment.
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Affiliation(s)
- Quan Lu
- Department of Gastroenterology, Shenzhen People’s Hospital, Shenzhen 518020, Guangdong Province, China
| | - Quan-Zhou Peng
- Department of Pathology, Shenzhen People’s Hospital, Shenzhen 518020, Guangdong Province, China
| | - Jun Yao
- Department of Gastroenterology, Shenzhen People’s Hospital, Shenzhen 518020, Guangdong Province, China
| | - Li-Sheng Wang
- Department of Gastroenterology, Shenzhen People’s Hospital, Shenzhen 518020, Guangdong Province, China
| | - De-Feng Li
- Department of Gastroenterology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, Shenzhen 518020, Guangdong Province, China
- The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen 518020, Guangdong Province, China
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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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3
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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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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: 0.3] [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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Erginoz E, Uludag SS, Cavus GH, Zengin K, Ozcelik MF. Clinicopathological features and management of colonic lipomas: Case reports. Medicine (Baltimore) 2022; 101:e29004. [PMID: 35451395 PMCID: PMC8913087 DOI: 10.1097/md.0000000000029004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/16/2022] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Colonic lipomas are benign tumors of adipose tissue that are often asymptomatic, but they may present with rectal bleeding or obstructive symptoms. These tumors are unique in that they are rarely encountered within the gastrointestinal system and can mimic malignant tumors in appearance. Surgical resection and endoscopic removal of tumors have been shown to be successful in their management. PATIENT CONCERNS In this report, we present 3 cases of colonic lipomas, 2 of which are located in the cecum and the other within the sigmoid colon. The presenting symptoms of the patients included abdominal pain, constipation, and dyspepsia. DIAGNOSIS Patients typically presented with anemia and an elevated C-reactive protein count. Colonoscopic and computerized tomography findings were used for diagnosis. INTERVENTIONS Hemicolectomy was performed, depending on the localization, and the pathologic specimens were consistent with lipoma. OUTCOMES Surgical resection was curative in all patients. The postoperative period was uneventful in all patients and all patients are symptom-free and alive at 3 years follow-up. CONCLUSION Colonic lipomas are benign mesenchymal tumors of the gastrointestinal system with a male predominance and are observed within the fourth to sixth decades of life. Various genetic abnormalities have been reported and they have been linked to the formation of intussusception. The squeeze sign on radiological imaging, cushion sign and tenting sign in colonoscopy, and naked fat sign during pathologic examination is helpful towards reaching a diagnosis. Surgical resection is the treatment of choice but minimally invasive endoscopic approaches have also been shown to be successful.
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Affiliation(s)
- Ergin Erginoz
- Department of General Surgery, Istanbul University Cerrahpasa – Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Server Sezgin Uludag
- Department of General Surgery, Istanbul University Cerrahpasa – Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Gokce Hande Cavus
- Department of Pathology, Istanbul University Cerrahpasa – Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Kagan Zengin
- Department of General Surgery, Istanbul University Cerrahpasa – Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Mehmet Faik Ozcelik
- Department of General Surgery, Istanbul University Cerrahpasa – Cerrahpasa School of Medicine, Istanbul, Turkey
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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: 0.3] [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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Lal A, Gupta P, Singhal M, Sinha SK, Lal S, Rana S, Khandelwal N. Abdominal lymphatic malformation: Spectrum of imaging findings. Indian J Radiol Imaging 2021; 26:423-428. [PMID: 28104932 PMCID: PMC5201068 DOI: 10.4103/0971-3026.195777] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Lymphatic malformations are congenital vascular malformations with lymphatic differentiation. Although the most common locations for lymphatic malformation are the neck and axilla, they can occur at several locations in the body including the abdomen. The abdominal location is rather rare and accounts for approximately 5% of all lymphatic malformation. Abdominal lymphatic malformation can arise from mesentery, omentum, gastrointestinal tract, and retroperitoneum. Clinical presentation includes an abdominal lump, vague abdominal discomfort, and secondary complications including intestinal obstruction, volvulus, ischemia, and bleeding. There is a broad spectrum of radiological manifestation. In the present review, we discuss the imaging appearance of abdominal lymphatic malformation. The diagnosis of lymphatic malformation in our series was based on the histopathological examination (in cases who underwent surgery) and fine needle aspiration cytology.
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Affiliation(s)
- Anupam Lal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Manphool Singhal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Saroj K Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sadhana Lal
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Surinder Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Yamamoto K, Ikeya T, Shiratori Y. Endoscopic unroofing and mucosal resection for a large colonic lipoma with intussusception: an effective hybrid technique. VideoGIE 2021; 6:190-192. [PMID: 33898900 PMCID: PMC8058103 DOI: 10.1016/j.vgie.2020.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Kazuki Yamamoto
- Department of Gastroenterology, St Luke's International Hospital, Tokyo, Japan
| | - Takashi Ikeya
- Department of Gastroenterology, St Luke's International Hospital, Tokyo, Japan
| | - Yasutoshi Shiratori
- Department of Gastroenterology, St Luke's International Hospital, Tokyo, Japan
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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: 3.6] [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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10
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Affiliation(s)
- Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
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11
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Akahoshi K, Oya M, Koga T, Shiratsuchi Y. Current clinical management of gastrointestinal stromal tumor. World J Gastroenterol 2018; 24:2806-2817. [PMID: 30018476 PMCID: PMC6048423 DOI: 10.3748/wjg.v24.i26.2806] [Citation(s) in RCA: 220] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/03/2018] [Accepted: 06/21/2018] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common malignant subepithelial lesions (SELs) of the gastrointestinal tract. They originate from the interstitial cells of Cajal located within the muscle layer and are characterized by over-expression of the tyrosine kinase receptor KIT. Pathologically, diagnosis of a GIST relies on morphology and immunohistochemistry [KIT and/or discovered on gastrointestinal stromal tumor 1 (DOG1) is generally positive]. The prognosis of this disease is associated with the tumor size and mitotic index. The standard treatment of a GIST without metastasis is surgical resection. A GIST with metastasis is usually only treated by tyrosine kinase inhibitors without radical cure; thus, early diagnosis is the only way to improve its prognosis. However, a GIST is usually detected as a SEL during endoscopy, and many benign and malignant conditions may manifest as SELs. Conventional endoscopic biopsy is difficult for tumors without ulceration. Most SELs have therefore been managed without a histological diagnosis. However, a favorable prognosis of a GIST is associated with early histological diagnosis and R0 resection. Endoscopic ultrasonography (EUS) and EUS-guided fine needle aspiration (EUS-FNA) are critical for an accurate diagnosis of SELs. EUS-FNA is safe and effective in enabling an early histological diagnosis and adequate treatment. This review outlines the current evidence for the diagnosis and management of GISTs, with an emphasis on early management of small SELs.
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Affiliation(s)
- Kazuya Akahoshi
- Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 820-8505, Japan
| | - Masafumi Oya
- Department of Pathology, Aso Iizuka Hospital, Iizuka 820-8505, Japan
| | - Tadashi Koga
- Department of Surgery, Aso Iizuka Hospital, Iizuka 820-8505, Japan
| | - Yuki Shiratsuchi
- Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 820-8505, Japan
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12
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Shi L, Zhao Y, Li W. Endoscopic resection of a giant colonic lipoma with endoloop-assisted unroofing technique: A case report. Medicine (Baltimore) 2018; 97:e10995. [PMID: 29879057 PMCID: PMC5999471 DOI: 10.1097/md.0000000000010995] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/15/2018] [Indexed: 12/24/2022] Open
Abstract
RATIONALE Colonic lipomas are uncommon benign submucosal adipose tumorsthat are usually asymptomatic. Large lipomas can cause symptoms require treatment in principle. We report 1 case of giant colonic lipoma removed with endoloop-assisted unroofing technique instead of conventional surgical bowel resection. PATIENT CONCERNS A 62-year-old female patient presented with intermittent abdominal discomfort for 1 month. DIAGNOSIS The patient was diagnosed as having a giant colonic lipoma. INTERVENTION Endoscopic resection with endoloop-assisted unroofing technique was performed. On the 22nd day after resection, intestinal obstruction occurred by shedding mass was found; the symptoms of this patient disappeared soon after removal of the mass by endoscopy. OUTCOMES A follow-up colonoscopy 6 months later showed a scarred mucosa at the ligation site and no residual lipoma was observed. LESSONS Endoscopic resection with endoloop-assisted unroofing technique remains a viable option for giant lipomas; however, postoperative intestinal obstruction caused by shedding mass should be noted.
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The role of endoscopy in subepithelial lesions of the GI tract. Gastrointest Endosc 2017; 85:1117-1132. [PMID: 28385194 DOI: 10.1016/j.gie.2017.02.022] [Citation(s) in RCA: 161] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 02/21/2017] [Indexed: 02/06/2023]
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A retrospective study on the safety, diagnostic yield, and therapeutic effects of endoscopic unroofing for small gastric subepithelial tumors. Gastrointest Endosc 2016; 84:924-929. [PMID: 27109457 DOI: 10.1016/j.gie.2016.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 04/07/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Accurate diagnosis of small gastric subepithelial tumors (SETs) is essential to assess their malignant potential. Endoscopic unroofing has been reported to yield sufficient tissue samples for histologic evaluation. This study aimed to evaluate the safety, diagnostic yield, and potential therapeutic effects of this technique over time. METHODS This retrospective analysis of prospectively collected clinical data identified patients who underwent endoscopic unroofing at the Medical University of Vienna from January 2003 to December 2012. Demographic data, indications for endoscopic unroofing, intraprocedural adverse events, hospital stay, histologic results, and follow-up procedures were reviewed. RESULTS A total of 14 patients (7 men; 7 women; median age, 70 years; range, 51-95 years) underwent endoscopic unroofing of 14 gastric SETs with a mean diameter of 26 ± 13 mm at EUS. In 9 of 14 cases, endoscopic unroofing was done exclusively for diagnostic purposes; in the remaining cases, it was performed with therapeutic intent because of bleeding from the gastric SETs. Unroofing was technically successful in 13 of 14 cases and revealed 8 cases of GI stromal tumor (GIST) and 1 case each of leiomyoma, fibroid polyp, glomus tumor, pancreatic rest, and nondiagnostic material at histology. Intraprocedural bleeding was the only adverse event (4 cases) and could be managed endoscopically. A follow-up EUS was available (median, 8 months) for 10 of the 14 patients. Notably, most patients showed complete regression of their gastric SETs after unroofing (on white light and EUS), including the glomus tumor, the leiomyoma, and 6 of the 8 cases of GIST. CONCLUSIONS Endoscopic unroofing was safe and had a very favorable diagnostic yield in this study. Unexpectedly, it led to complete regression in most gastric SETs. Although it is not an oncologically curative treatment, endoscopic unroofing can be a valuable option to treat local adverse events in patients unfit for surgical therapy. (Clinical trial registration number: NCT02587923.).
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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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Arraiza M, Metser U, Vajpeyi R, Khalili K, Hanbidge A, Kennedy E, Ghai S. Primary cystic peritoneal masses and mimickers: spectrum of diseases with pathologic correlation. ACTA ACUST UNITED AC 2015; 40:875-906. [PMID: 25269999 DOI: 10.1007/s00261-014-0250-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Cystic lesions within the peritoneum have been classified classically according to their lining on histology into four categories-endothelial, epithelial, mesothelial, and others (germ cell tumors, sex cord gonadal stromal tumors, cystic mesenchymal tumors, fibrous wall tumors, and infectious cystic peritoneal lesions). In this article, we will proceed to classify cystic peritoneal lesions focusing on the degree of radiological complexity into three categories-simple cystic, mildly complex, and cystic with solid component lesions. Many intra-abdominal collections within the peritoneal cavity such as abscess, seroma, biloma, urinoma, or lymphocele may mimic primary peritoneal cystic masses and need to be differentiated. Clinical history and imaging features may help differentiate intra-abdominal collections from primary peritoneal masses. Lymphangiomas are benign multilocular cystic masses that can virtually occur in any location within the abdomen and insinuate between structures. Ultrasound may help differentiate enteric duplication cysts from other mesenteric and omental cysts in the abdomen. Double-layered wall along the mesenteric side of bowel may suggest its diagnosis in the proper clinical setting. Characteristic imaging features of hydatid cysts are internal daughter cysts, floating membranes and matrix, peripheral calcifications, and collagenous pericyst. Non-pancreatic psuedocysts usually have a fibrotic thick wall and chylous content may lead to a fat-fluid level. Pseudomyxoma peritonei appears as loculated fluid collections in the peritoneal cavity, omentum, and mesentery and may scallop visceral surfaces. Many of the primary cystic peritoneal masses have specific imaging features which can help in accurate diagnosis and management of these entities. Knowledge of the imaging spectrum of cystic peritoneal masses is necessary to distinguish from other potential cystic abdominal mimicker masses.
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Affiliation(s)
- María Arraiza
- Joint Department of Medical Imaging, University Health Network - Mount Sinai Hospital - Women's College Hospital, University of Toronto, 585 University Avenue, Toronto, ON, M5G 2N2, Canada
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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: 0.5] [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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Hotta K, Imai K, Shimoda T. Lymphangioma of the colon: a curious endoscopic finding. Clin Gastroenterol Hepatol 2014; 12:A24. [PMID: 24929236 DOI: 10.1016/j.cgh.2014.05.025] [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] [Received: 05/21/2014] [Accepted: 05/30/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kenichiro Imai
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
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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: 30] [Impact Index Per Article: 2.7] [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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Kim GW, Kwon CI, Song SH, Jin SM, Kim KH, Moon JH, Hong SP, Park PW. Endoscopic resection of giant colonic lipoma: case series with partial resection. Clin Endosc 2013; 46:586-90. [PMID: 24143327 PMCID: PMC3797950 DOI: 10.5946/ce.2013.46.5.586] [Citation(s) in RCA: 16] [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: 09/04/2012] [Revised: 10/06/2012] [Accepted: 10/11/2012] [Indexed: 12/15/2022] Open
Abstract
Colonic lipoma, a very rare form of benign tumor, is typically detected incidentally in asymptomatic patients. The size of lipoma is reported variously from 2 mm to 30 cm, with higher likelihood of symptoms as the size is bigger. Cases with symptom or bigger lesion are surgically resected in principle; endoscopic resection, which has developed recently with groundbreaking advance of endoscopic excision technology, is being used more often but with rare report of success due to high chance of complications such as bowel perforation or bleeding. The authors report here, together with a literature review, our experiences of three cases of giant colonic lipomas showing complete remission after aggressive unroofing technique, at certain intervals, using snare catheter at the origin of the lipoma so that the remaining lipoma could be drained out of the exposed surface spontaneously, in order to reduce complications.
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Affiliation(s)
- Gun Woo Kim
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Park H, Chung JW, Kim AJ, Park SY, Rim MY, Jang YR, Lee JH, Park S. A case of rectal mucosa-associated lymphoid tissue lymphoma diagnosed by endoscopic unroofing technique. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2012; 59:428-32. [PMID: 22735876 DOI: 10.4166/kjg.2012.59.6.428] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Mucosa-associated lymphoid tissue (MALT) lymphoma is a typical primary gastrointestinal lymphoma, particularly in the stomach. Although primary rectal lymphoma is rare, it may present as a subepithelial tumor. Several techniques have been proposed for a tissue diagnosis in subepithelial tumor, including endoscopic ultrasonography (EUS)-guided fine needle aspiration (EUS-FNA), EUS-guided trucut biopsy (EUS-TCB), and tacked biopsy. However the diagnostic efficacy of these techniques appears to be limited. The unroofing technique involves removal of the overlying mucosa, thereby exposing the subepithelial lesion. It was originally reported as a method for endoscopic treatment of colorectal lymphangioma. In this case, a subepithelial tumor of the rectum was diagnosed using the endoscopic unroofing technique. This is a useful modality for the diagnosis of subepithelial tumor, because it provides histologic results in a safe and rapid manner.
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Affiliation(s)
- Hyeonsu Park
- Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, 1198, Guwol-dong, Namdong-gu, Incheon 405-760, Korea
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Zhuang JB, Zhang JH, Chen L, Yuan JX. Endoscopic ultrasound in combination with pathological examination for diagnosis of duodenal Brunner's gland hyperplasia and selection of appropriate endoscopic treatment. Shijie Huaren Xiaohua Zazhi 2010; 18:3572-3575. [DOI: 10.11569/wcjd.v18.i33.3572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
AIM: To explore the value of endoscopic ultrasound (EUS) in combination with pathological examination in the diagnosis of duodenal Brunner's gland hyperplasia and to examine the role of EUS in guiding the selection of appropriate endoscopic treatment.
METHODS: Nine patients diagnosed with duodenal elevated lesions by gastroscopy were examined by EUS, and different endoscopic treatments were chosen base on the findings from EUS. Biopsies obtained before and after treatment were subjected to pathological examination to confirm the diagnosis of Brunner's gland hyperplasia. Gastroscopy was performed again one month after therapy.
RESULTS: (1) Gastroscopy: Of all nine patients, 3 had polyps and 6 had cysts; 3 had pedunculated lesions, 5 had non-pedunculated lesions, and 1 had a flat elevation lesion; (2) EUS diagnosis: Seven patients had duodenal submucosal cystic lesions - Brunner's gland hyperplasia, and 2 patients had duodenal polyps; (3) Endoscopic treatment: Five non-pedunculated cystic lesions underwent wall removal using rat tooth forceps, 3 pedunculated lesions were resected by snare electrocoagulation, and 1 small flat lesion was resected with argon ion beam. No massive bleeding or perforation occurred.
CONCLUSION: It is difficult to distinguish Brunner's gland hyperplasia, polyp and cyst by gastroscopy. EUS has higher value in differentially diagnosing these diseases and guiding the selection of appropriate endoscopic treatment.
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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: 25] [Impact Index Per Article: 1.7] [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: 20] [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: 4.9] [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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Zhang JH, Zhuang JB, Miao LS, Yuan JX, Chen L. Endoscopic diagnosis and therapy for cystic tumors in duodenum. Shijie Huaren Xiaohua Zazhi 2008; 16:3925-3927. [DOI: 10.11569/wcjd.v16.i34.3925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
AIM: To investigate the endoscopic diagnosis and therapy for cystic tumors in duodenum.
METHODS: Three cases of cystic tumors in duodenum were diagnosed through routine gastroscopy and endoscopic ultrasonography. Cystic tumors were treated with cystoscopy therapy.
RESULTS: Three cases of cystic tumors confirmed by endoscopic ultrasonography were endoscopically treated with rat-like teeth biopsy forceps. One month later, endoscopy review showed that cystic tumors completely disappeared. The desired therapeutic effect was achieved.
CONCLUSION: The endoscopic ultrasonography is of important value to the diagnosis of cystic tumors in the duodenum. The treatment method with rat-like teeth biopsy forceps is a simple, safe and effective therapy for the cystic tumors in the duodenum.
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Huang WH, Peng CY, Yu CJ, Chou JW, Feng CL. Endoloop-assisted unroofing for the treatment of symptomatic duodenal lipomas. Gastrointest Endosc 2008; 68:1234-6. [PMID: 19028236 DOI: 10.1016/j.gie.2008.03.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Accepted: 03/03/2008] [Indexed: 12/13/2022]
Affiliation(s)
- Wen-Hsin Huang
- Department of Internal Medicine, Division of Hepatogastroenterology, China Medical University Hospital, Taichung, Taiwan
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Lee SH, Park JH, Park DH, Chung IK, Kim HS, Park SH, Kim SJ, Cho HD. Endoloop ligation of large pedunculated submucosal tumors (with videos). Gastrointest Endosc 2008; 67:556-60. [PMID: 18294522 DOI: 10.1016/j.gie.2007.10.049] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Accepted: 10/29/2007] [Indexed: 12/16/2022]
Abstract
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.
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Affiliation(s)
- Suck-Ho Lee
- Department of Internal Medicine, Soon Chun Hyang University Cheonan Hospital, Cheonan, Korea
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Sou S, Nomura H, Takaki Y, Nagahama T, Matsubara F, Matsui T, Yao T. Hemorrhagic duodenal lipoma managed by endoscopic resection. J Gastroenterol Hepatol 2006; 21:479-81. [PMID: 16509883 DOI: 10.1111/j.1440-1746.2006.03178.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
The patient, an 81-year-old woman, was admitted to our hospital for a detailed examination; the chief complaint being melena. An upper gastrointestinal roentgenologic study revealed a submucosal tumor with a smooth surface and a stalk measuring 50 mm at the third part of the duodenum. Endoscopy depicted it as a yellowish submucosal tumor. Based on computed tomography and fluoroscopy of the small intestine, a diagnosis of duodenal lipoma was made. The esophagus, stomach, and the small and large intestines were free of lesions so the duodenal lipoma was judged to be the hemorrhagic source. The tumor was endoscopically polypectomized using a 2-channel scope. The excised specimen, measuring 50 x 20 x 20 mm, was covered by a normal duodenal mucosa with small ulcers in part. Photomicrographic findings included a tumor that was composed of mature adipose tissue in the submucosa, which coincided with a diagnosis of lipoma. Small ulcers had formed in part, exposing vessels, thus indicating the cause for hemorrhage. Lipoma is a benign tumor; and if the lesion is found to be pedunculated and an endoscope can reach it for treatment, minimally invasive endoscopic procedures should be selected.
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Affiliation(s)
- Suketo Sou
- Department of Gastroenterology, Shin-Kokura Hospital, Kanada, Kokurakita-ku, Kitakyushu, Japan.
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31
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Levy AD, Cantisani V, Miettinen M. Abdominal lymphangiomas: imaging features with pathologic correlation. AJR Am J Roentgenol 2004; 182:1485-91. [PMID: 15149994 DOI: 10.2214/ajr.182.6.1821485] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Angela D Levy
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, 6825 16th Street NW, Washington, DC 20306-6000, USA.
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MIKI KAZUMASA. Unroofing technique for the endoscopic resection of an asymptomatic, large gastric lipoma. A new approach to the endoscopic treatment. Dig Endosc 2003. [DOI: 10.1046/j.1443-1661.2003.00256.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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FUKUDA SHINSAKU, YAMAGATA RYO, MIKAMI TATSUYA, SHIMOYAMA TADASHI, SAWAYA MANABU, UNO YOSHIHARU, TANAKA MASANORI, MUNAKATA AKIHIRO. Gastric lipoma successfully treated by endoscopic unroofing. Dig Endosc 2003. [DOI: 10.1046/j.1443-1661.2003.00252.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Tung CF, Chow WK, Peng YC, Chen GH, Yang DY, Kwan PC. Bleeding duodenal lipoma successfully treated with endoscopic polypectomy. Gastrointest Endosc 2001; 54:116-7. [PMID: 11427861 DOI: 10.1067/mge.2001.113916] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- C F Tung
- Department of Emergency Medicine, Division of Gastroenterology, Chung Shan Medical and Dental College, and Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
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Ajiki T, Nakamura T, Kubota S, Kim YS, Kuroda Y. Successful endoscopic treatment of colon lymphangioma with a ligating device. Gastrointest Endosc 2000; 52:800-2. [PMID: 11115927 DOI: 10.1067/mge.2000.108661] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- T Ajiki
- First Department of Surgery, Kobe University School of Medicine, Department of Clinical Pathology and Laboratory Medicine, National Kobe Hospital, Kobe, Japan
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Kim KM, Choi KY, Lee A, Kim BK. Lymphangioma of large intestine: report of ten cases with endoscopic and pathologic correlation. Gastrointest Endosc 2000; 52:255-9. [PMID: 10922105 DOI: 10.1067/mge.2000.107710] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Lymphangioma of the intestinal tracts is extremely rare and usually presents as a sessile or pedunculated polyp. The cause of these gross morphologic differences is unknown. The aim of this study was to investigate the characteristic histopathology of the colonic lymphangiomas in comparison with their endoscopic findings. METHODS Ten colonic lymphangiomas, diagnosed and resected endoscopically between 1992 and 1999, were microscopically examined and immunohistochemically stained with CD31, CD34, Factor VIII-related antigen, and smooth muscle actin. RESULTS The characteristic endoscopic finding was a transparent, fluctuating sessile (7 cases) or pedunculated (3 cases) polypoid mass with the color of normal colonic mucosa. Proliferative and dilated lymphatic tumor vessels were found in the colonic mucosa as well as in the submucosa in seven cases. In three pedunculated lymphangiomas, dilated lymphatics were exclusively restricted to the submucosa. The endothelial lining cells stained positively for both CD31 and Factor VIII-related antigen in all 10 cases tested, but most cases were negative for CD34. CONCLUSION A pedicle does not exclude the endoscopic diagnosis of lymphangioma and there is a close correlation between its presence and histologic submucosal localization of dilated lymphatic vessels.
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Affiliation(s)
- K M Kim
- Departments of Gastroenterology and Clinical Pathology, Catholic University, College of Medicine, Seoul, Korea
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Sriram PV, Weise C, Seitz U, Brand B, Schröder S, Soehendra N. Lymphangioma of the major duodenal papilla presenting as acute pancreatitis: treatment by endoscopic snare papillectomy. Gastrointest Endosc 2000; 51:733-6. [PMID: 10840315 DOI: 10.1067/mge.2000.106111] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- P V Sriram
- Department of Endoscopic Surgery, University Hospital Eppendorf and Pathologie, Labor Keeser/Arndt, Hamburg, Germany
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Affiliation(s)
- A Ishiguro
- First Department of Internal Medicine, Hirosaki University School of Medicine, Zaifu-Cyo, Japan
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Hizawa K, Kawasaki M, Kouzuki T, Aoyagi K, Fujishima M. Unroofing technique for the endoscopic resection of a large duodenal lipoma. Gastrointest Endosc 1999; 49:391-2. [PMID: 10049428 DOI: 10.1016/s0016-5107(99)70021-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- K Hizawa
- Second Department of Internal Medicine and Second Department of Pathology, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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