Endoscopic removal of large colonic lipomas

Colonic lipomas are benign adipose tumors that rarely cause symptoms. Removal of lipomas 2 cm or greater in diameter has been associated with a greater risk of perforation. Experience with the evaluation and removal of large colonic lipomas with the assistance of EUS to reduce the risk of perforation is reported.

Four patients with large colonic lipomas were evaluated and treated with endoscopic methods. EUS was performed to confirm that the lesion was a lipoma superficial to the muscularis propria. Saline or epinephrine solution was injected at the base of the tumor, which was then resected electrosurgically with a snare.

All 4 lesions were successfully removed and histopathologically confirmed to be lipomas (mean maximal diameter 2.8 cm). There were no complications of any procedure. One patient was hospitalized overnight because of abdominal pain that resolved without complication.

Large colonic lipomas can be removed safely by electrosurgical snare resection after injection of the base with epinephrine or saline solution. EUS should be used to ensure that the lipoma does not extend into the muscularis propria. Clinical judgment is important in assessing the need to remove these lesions.