Bae Jun Yong, Kim Hun Kyu, Kim Yee Jin, Kim Se Woong, Lee Youngeun, Ryu Chang Beom, Lee Moon Sung
Internal Medicine and Digestive Disease Center, Seoul Medical Center, Seoul 02053, South Korea.
Department of Pathology, Seoul Medical Center, Seoul 02053, South Korea.
World J Clin Cases. 2023 Sep 16;11(26):6194-6199. doi: 10.12998/wjcc.v11.i26.6194.
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.
由于脂肪不能很好地传导电能，在内镜下切除结肠脂肪瘤时，因电热损伤导致的延迟穿孔和息肉切除术后综合征是需要关注的问题。内镜黏膜下剥离术（ESD）技术将电能集中传导至黏膜下层，而非脂肪组织。这有助于将电热损伤降至最低，尤其是对于较大的结肠脂肪瘤。在罕见情况下，如伴有黏膜病变的结肠脂肪瘤，内镜医师很难决定如何安全地切除它们。
一名78岁男性因结直肠癌筛查接受结肠镜检查。结肠镜检查期间，在升结肠观察到一个约4.5 cm的黄色黏膜下肿瘤，有阳性垫征。在脂肪瘤的黏膜表面观察到一个约2.5 cm的结节状黏膜病变。脂肪瘤很大，占据了结肠内部的大部分空间，使得难以一次性看清整个侧向发育型肿瘤（LST）。LST局限于脂肪瘤表面，呈半蒂状，颈部较宽。在脂肪瘤颈部未观察到LST的边缘。实施了ESD，成功切除了伴有LST的结肠脂肪瘤，无并发症发生。住院3天后，患者无症状出院。最终病理报告显示病变由黏膜下脂肪瘤和低级别异型增生的管状绒毛状腺瘤组成。
ESD通过将电热损伤降至最低，对于治疗伴有LST的大结肠脂肪瘤有效且安全。
