Endoscopic Ligation Facilitates Treatment of Colonic Lipomas

A new study suggests that the endoscopic “loop-and-let-go” technique is a safe and efficacious treatment for large colonic lipomas (CLs).

Researchers at University Hospital Center Zagreb (Croatia) and Marienhospital (Bottrop, Germany; www.mhb-bottrop.de) performed a total of 6,929 colonoscopies in 5,563 patients. Of these, 11 patients (0.02%) were identified with large CL after being referred for colonoscopy following altered bowel habits, for screening of colorectal neoplasm, and due to lower gastrointestinal bleeding; the median CL lesion size identified was 3 cm. Lesions were located at the hepatic flexure (36%), cecum and ascending colon (36%), rectosigmoid colon (18%), and transverse colon (9%).

CL was confirmed clinically using the “pillow” sign (indentation of the lesion on probing with a closed biopsy forceps) and the “naked fat” sign (extrusion of the fat after repeated biopsies done at the same location). Following diagnosis, the lipomas were looped and ligated with a detachable snare loop (endoloop). The technique involves the nylon snare of the endoloop inserted into the lumen and maneuvered to capture the head of the lipoma and carefully advanced to the stalk. The plastic sheath of the endoloop is then slowly advanced for controlled closure, and then the snare completely tightened around the stalk.

If needed, prior to the placement of the endoloop, the patient is repositioned to suspend the lipoma and to obtain the best view of the base or the stalk. Following the procedure, there were no immediate or late complications. Follow-up colonoscopies were scheduled at 1- and 3-months interval, and only one small residual lipoma (less than 1 cm in diameter) was found. The study was published on July 8, 2014, in BMC Gastroenterology.

“This technique has several potential advantages over existing methods of endoscopic removal, as the “loop and let go” technique avoids the risks associated with electrocautery, potential less hospital stay, and theoretical advantage of less perforation,” concluded lead author Hrvoje Ivekovic, MD, of University Hospital Center Zagreb, and colleagues. “Specifically, when dealing with fatty tissue and lipomas, any endosocpist has certainly endured the difficult situation of having to apply massive amounts of currents to finally resect these lesions.”

For the study the researchers used the Olympus Endoloop, a product of Olympus (Tokyo, Japan).

Related Links:

University Hospital Center Zagreb

Marienhospital

Olympus