Underwater endoscopic submucosal dissection for large colonic lipomas: a case series

Colonic lipomas are benign tumors arising from mature adipose tissue and are usually asymptomatic; however, they can occasionally lead to adverse events, such as intussusception, abdominal pain, and GI bleeding. Colonic lipomas can be removed using a variety of endoscopic techniques, including endoscopic unroofing, loop-assisted resection, EMR, and endoscopic submucosal dissection (ESD). However, symptomatic lipomas are often large, and the visualization of the lipoma base during resection is difficult, rendering treatment challenging. Here, we report a case series of patients with large colonic lipomas who underwent underwater ESD (U-ESD).

Between April 2024 and March 2025, 4 patients with symptomatic or large colonic lipomas (≥30 mm), which were identified during colonoscopy, underwent U-ESD at our center.

The buoyancy-based underwater technique provided continuous countertraction enhanced the visualization of the lesion base, and improved exposure of the dissection plane. In all 4 cases, lesions were safely and efficiently resected by U-ESD.

U-ESD may be considered a useful approach for the endoscopic resection of large colonic lipomas.