Endoscopic Resection of Giant Colonic Lipoma: Case Series with Partial Resection
A 48-year-old male was referred to the center with diagnosis of a benign lesion in the ascending colon detected by abdominal-pelvic computed tomography and abdominal discomfort in the right lower quadrant. At colonoscopy, a 4×7-cm cylindrical protruding mass without mucosal change was detected originating from the proximal ascending colon (). As the size of the mass was much bigger than the other cases, we first tried partial resection with a snare catheter at the apical end of the mass unlike the other cases. At the Endo-cut mode (120 W, effect 3), partial resection was performed for 20 seconds unsuccessfully due to the impeded conduction of the electric current by the submucosal lipoma tissue (). It was found that the diameter of the mass became decreased toward the base of the cylindrical mass, which was why we retried partial resection slightly apart from the origin. Simulations were performed several times near the base of the mass, before performing the resection, in order to find the proper placement of the snare catheter with optimal constriction while avoiding possible thermal injury (). Partial resection was performed for less than 5 seconds to reset most of the mass. Typical yellow tissue indicating lipoma could be observed on the exposed surface (). As observed from the resected specimen of the mass, the apical end of the mass was too thick to apply electric current without inflicting severe thermal injury on the adjacent tissues, while the actual resected part was relatively thinner and the electric current was well-applied with rare thermal injury on the adjacent tissues (). The patient was relieved of the abdominal discomfort afterwards. At 1-year follow-up colonoscopy, a surgical scar was observed but not any remaining lipoma.