VIDEOGIE Todd H. Baron, MD, G. S. Raju, MD, Editors for VideoGIE
Giant esophageal lipoma: endoscopic resection
Figure 1. A, Submucosal esophageal lesion. B, Ex vivo specimen.
Lipomas of the upper GI tract rarely cause symptoms. Esophageal lipomas are very rare entities that, if large enough, may result in dysphagia. A 72-year-old man was evaluated because of a 6-month history of dysphagia and food regurgitation. Initial upper GI endoscopy revealed a large esophageal submucosal mass with normal overlying mucosa. The patient was referred to Duke University Health Center for further evaluation before planned surgical intervention. Endoscopically, a large, mobile, submucosal lesion was identified in the midesophagus (Fig. 1A; Video 1, available at www.giejournal.org). The lesion slid freely along the esophagus on a broad-based stalk. Endosonographic evaluation demonstrated a hyperechoic submucosal lesion suggestive of a lipoma. No regional lymph nodes were seen. The decision was made to endoscopically resect the lesion. This was done by hot snare polypectomy after a submucosal injection with saline solution, methylene blue, and epinephrine. The 6-cm lesion was successfully retrieved. The resection defect was then closed with endoclips. The patient was discharged home on the same day, and on follow-up was noted to have resolution of his
www.giejournal.org
symptoms. Pathologic examination demonstrated a large lipoma (Fig. 1B). Given that liposarcomas may have a similar appearance, MDM2 fluorescence in situ hybridization analysis was performed, and the result was negative. Symptomatic lesions of this size are typically managed surgically; however, this case demonstrates that selected cases are amenable to endoscopic resection. DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Danny Cheriyan, MB, Bch, BAO, MRCPI, Division of Gastroenterology, Cynthia Guy, MD, Division of Pathology, Rebecca Burbridge, MD, Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina, USA
http://dx.doi.org/10.1016/j.gie.2015.05.005
Volume
-,
No.
-
: 2015 GASTROINTESTINAL ENDOSCOPY 1
Giant esophageal lipoma: endoscopic resection
Figure 1. A, Submucosal esophageal lesion. B, Ex vivo specimen.
Lipomas of the upper GI tract rarely cause symptoms. Esophageal lipomas are very rare entities that, if large enough, may result in dysphagia. A 72-year-old man was evaluated because of a 6-month history of dysphagia and food regurgitation. Initial upper GI endoscopy revealed a large esophageal submucosal mass with normal overlying mucosa. The patient was referred to Duke University Health Center for further evaluation before planned surgical intervention. Endoscopically, a large, mobile, submucosal lesion was identified in the midesophagus (Fig. 1A; Video 1, available at www.giejournal.org). The lesion slid freely along the esophagus on a broad-based stalk. Endosonographic evaluation demonstrated a hyperechoic submucosal lesion suggestive of a lipoma. No regional lymph nodes were seen. The decision was made to endoscopically resect the lesion. This was done by hot snare polypectomy after a submucosal injection with saline solution, methylene blue, and epinephrine. The 6-cm lesion was successfully retrieved. The resection defect was then closed with endoclips. The patient was discharged home on the same day, and on follow-up was noted to have resolution of his
www.giejournal.org
symptoms. Pathologic examination demonstrated a large lipoma (Fig. 1B). Given that liposarcomas may have a similar appearance, MDM2 fluorescence in situ hybridization analysis was performed, and the result was negative. Symptomatic lesions of this size are typically managed surgically; however, this case demonstrates that selected cases are amenable to endoscopic resection. DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Danny Cheriyan, MB, Bch, BAO, MRCPI, Division of Gastroenterology, Cynthia Guy, MD, Division of Pathology, Rebecca Burbridge, MD, Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina, USA
http://dx.doi.org/10.1016/j.gie.2015.05.005
Volume
-,
No.
-
: 2015 GASTROINTESTINAL ENDOSCOPY 1
