Published online Sep 16, 2023. doi: 10.12998/wjcc.v11.i26.6194
Peer-review started: May 27, 2023
First decision: July 23, 2023
Revised: August 2, 2023
Accepted: August 17, 2023
Article in press: August 17, 2023
Published online: September 16, 2023
Processing time: 104 Days and 3.4 Hours
Since fat does not transmit electrical energy well, delayed perforation and post-polypectomy syndrome due to electrical thermal injury are concerns in the endoscopic removal of colonic lipoma. The endoscopic submucosal dissection (ESD) technique concentrates electrical energy conducts to the submucosa, not the adipose tissue. This helps to minimize electrical thermal injury, especially in the case of large colonic lipomas. In rare cases, such as colonic lipomas accompanied by mucosal lesions, it is difficult for endoscopists to decide how to safely remove them.
A 78-year-old man underwent colonoscopy for colorectal cancer screening. During colonoscopy, a yellowish submucosal tumor with positive cushion sign was observed in the ascending colon measuring about 4.5 cm. A nodular mucosal lesion of about 2.5 cm was observed on the mucosal surface of the lipoma. The lipoma was so large that it occupied much of the inside of the colon, making it difficult to see the entire laterally spreading tumor (LST) at once. The LST was confined to the surface of the lipoma, which had a semipedunculated shape with a wide neck. The margin of the LST was not observed at the neck of the lipoma. ESD was performed and the colonic lipoma with the LST was successfully removed without complications. After 3 d of hospitalization, the patient was discharged without any symptoms. The final pathology report showed that the lesion consisted of submucosal lipoma and tubulovillous adenoma with low-grade dysplasia.
ESD is effective and safe for treating a large colonic lipoma with an LST by minimizing electrical thermal injury.
Core Tip: Most colonic lipomas are asymptomatic and do not require removal. Mucosal lesions of colorectal lipomas are rarely observed, but removal is necessary if there is a precancerous mucosal lesion such as tubular adenoma or tubulovillous adenoma. Due to the poor electrical conductivity of fat, excessive electrical energy during the endoscopic removal can cause complications. Endoscopic submucosal dissection is a preferred technique to minimize electrical thermal injury, especially for large colonic lipomas with a mucosal lesion.