Published online Sep 14, 2022. doi: 10.3748/wjg.v28.i34.5086
Peer-review started: March 3, 2022
First decision: June 11, 2022
Revised: July 24, 2022
Accepted: August 21, 2022
Article in press: August 21, 2022
Published online: September 14, 2022
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.
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.
Deep biopsy could lead to spontaneous GI lipoma expulsion. This might be the first step in lipoma diagnosis and treatment.
Core Tip: Gastrointestinal lipomas are benign tumors consisting of mature adipocytes. Symptomatic patients may require endoscopic or surgical treatment. Here, we report a case of duodenal papillary lipoma, which was spontaneously expelled 12 d after a bite-on-bite deep biopsy with forceps. The spontaneous expulsion of the lipoma shows the possibility of performing a deep biopsy as a fenestration in the first step as a diagnostic and therapeutic procedure.