A Case of Gastric Lipoma Removed by Endoscopic Polypectomy

Abstract: A rare case of gastric lipoma removed by endoscopic polypectomy is presented herein. A 64-year-old female was found to have a polypoid lesion in the stomach on periodic X-ray examination. Endoscopy revealed a submucosal tumor located on the posterior wall of the antrum. Endoscopic ultrasonography demonstrated a homogeneous, hyperechoic mass continuous with the submucosal layer, suggesting a lipoma. Because the likelihood of the tumor ultimately causing obstruction or prolapse into the duodenum was high, endoscopic polypectomy was performed. There were no complications. The histological examination revealed a mass of mature adipose tissue underneath the normal mucosa, which was consistent with the diagnosis made prior to polypectomy. The preferred treatment for gastric lipomas to date has been surgical excision, because the diagnosis is difficult to make prior to treatment. In the literature, only 17 cases undergoing endoscopic treatment for gastric lipomas have been reported. Endoscopic ultrasonography and computed tomography apparently facilitate preoperative diagnosis of lipomas.     

Duodenal Lipoma -A Report of Two Cases Resected by Endoscopic Polypectomy-

Duodenal lipomas are rarely reported. We reported two asymptomatic pedunculated duodenal lipomas successfully resected by endoscopic polypectomy. Case 1 was a 48-year-old Chinese female who came for a physical check-up. Upper gastrointestinal series and endoscopic examination revealed a 2.0 × 1.0 cm pedunculated polyp in the posterior wall of the bulb. Case 2 was a 67-year-old female. A 1.7 times 1.0 cm olive-shaped pedunculated polyp was found by endoscopic examination during a health check-up. Both tumors were polypectomised by endoscopy and proven to be duodenal lipomas pathologically. The diagnosis of duodenal lipoma has largely been made by surgery and autopsy in the past. It may be made nowadays with abdominal computed tomography and repeated deep biopsies. Duodenal lipomas may be treated by endoscopic polypectomy if the tumor is small and pedunculated.>     

Colonic Lipoma Removed by Endoscopic Polypectomy:—A Report of Three Cases—

We report on three cases of colonic lipoma removed by endoscopic polypectomy. Patient 1 was a 46-year-old female, Patient 2 a 63-year-old male and Patient 3 a 76-year-old female, with their afflicted regions being the; ascending colon, ascending colon and transverse colon, respectively. All the three lipomas were pedunculated and smooth on the surface, with the subrnucosal figure presenting yellowish or reddish in color. In Patient 1 and Patient 2, both tumors were totally removed, and in Patient 3, a “half resection” of the polyp was performed by endoscopic polypectomy. The resected specimens were 1.5 cm, 2.6 cm and 1.0 cm, respectively, in size at their maximum diameter and soft tumors with uniformly yellow cut-surfaces. All were histopathologically diagnosed as being “lipoma”. Because the colonic lipoma is benign, an endoscopic polypectomy should be tried as the treatment of choice in selected patients.     

A Case of Terminal Ileum Lipoma Treated by Endoscopic Polypectomy

Abstract: This study reports on the case of a 71-year-old man who complained of repeated episodes of right lower abdominal pain. A barium enema and colonoscopy revealed a 20 times 20 times 15 mm smooth-surfaced polypoid tumor (Yamada type III) located in the terminal ileum. An endoscopy showed that the lesion had a slightly yellowish surface and the cushion sign was observed, so the tumor was considered to be an intestinal lipoma. During colonoscopy, prolapse of the tumor occurred through the orifice of Bauhin's valve and the patient simultaneously complained of right lower abdominal pain. The tumor was removed endoscopically. After a colonoscopic polypectomy, the patient's right lower abdominal pain disappeared. A pathological examination of the specimen revealed a lipoma of the terminal ileum. In general, the correct preoperative diagnosis of intestinal lipoma is difficult. Furthermore, 80% of lipomas situated at the terminal ileum are complicated by acute intussusception. We suggest that a colonoscopic polypectomy is a useful procedure for confirming the diagnosis of intestinal lipoma and for the prophylaxis of intussusception when the tumor is located in the terminal ileum.     

Endoscopic Resection of Rectal Carcinoids Using Double Snare Polypectomy Technique

Abstract: Between 1993 and 1997, 11 patients with rectal carcinoids less than 8 mm in diameter (mean size: 5.5 mm) were endoscopically treated at Tsuboi Hospital. Seven patients were treated by polypectomy or endoscopic mucosal resection. Three of the seven lesions were microscopically diagnosed as having positive submucosal margins. The remaining four showed a distance between the tumor and the resection line(DBTRL) of 0 to 0.33 mm. Then, we attempted endoscopic double snare polypectomy (EDSP) in 1996 and 1997. In four consecutive patients, the tumor was completely resected by this method. The DBTRL ranged from 0.08 to 0.75 mm in four lesions resected by EDSP. With endoscopic resection of these tumors, the incidence of positive margins is high using the conventional single snare methods, even when the lesions are less than 10 mm in diameter. EDSP was useful for total removal of small rectal carcinoids.     

A Large Juvenile Polyp Successfully Treated by Endoscopic Polypectomy with a Detachable Snare

Abstract: A 43-year-old man was referred to our hospital because of a three week history of intermittent hematochezia. Barium enema study and colonoscopy revealed a large pedunculated polyp measuring 35 mm in diameter in the descending colon. Endoscopic polypectomy was performed using a detachable snare as an auxiliary device to ensure hemostasis. The detachable snare was considered useful in performing endoscopic polypectomy for this pedunculated polyp which had a particularly thick stalk. Furthermore, we consider this device to potentially play an important role in widening the indications for endoscopic polypectomy.     

Pedunculated Submucosal Ectopic Mucosa of the Stomach Treated by Endoscopic Polypectomy: Report of Two Cases

We report here two cases of submucosal ectopic gastric mucosa which grew with pedunculation. A lesion 23 mm in size was located in the posterior wall of the upper gastric body in a 61-year-old female. A 58-year-old female had a lesion 12 mm in size in the anterior wall of the upper gastric body. Both were elevated lesions expressed as Yamada's type IV and were endoscopically diagnosed as submucosal tumors. For the purpose of total biopsy, endoscopic polypectomy was performed in both cases. Histological examination of the polypectomized specimens showed gastric mucosa in the submucosal layer. These two cases were unique in that ectopic gastric mucosa was pedunculated and diagnosed after endoscopic polypectomy, not by postoperative pathological examination.     

Endoscopic management of mucosal lesions in the gastrointestinal tract

With the increasing role of endoscopy in patient evaluation, more mucosal lesions, including gastric, duodenal and colonic polyps, are encountered during routine examinations. It is imperative for gastroenterologists to become familiar with the endoscopic management of these various gastrointestinal lesions. In this article, various resection techniques will be discussed, including hot/cold forceps polypectomy, hot/cold snare polypectomy, endoscopic mucosal resection, and endoscopic submucosal dissection. The article will also discuss the evidence regarding the efficacy and safety of these techniques and the future direction of endoscopic management of mucosal lesions in the gastrointestinal tract.     

Esophageal Granular Cell Tumor Removed by Endoscopic Polypectomy

Granular cell tumors are rare neoplasms that are generally benign. They are usually found in the tongue, subcutaneous tissues, and breast. Since Abrikossof first described the histology of this tumor in 1926, there have been 86 cases involving the esophagus discussed in the literature. There is a low likelihood of these tumors becoming malignant and recurrence after resection is rare. However, these tumors can be confused with more malignant lesions. We report an additional case involving the esophagus and offer new management guidelines in the era of fiberoptic endoscopy.     

Endoscopic Resection of Small Gastric Adenoma

Abstract: We endoscopically resected 32 small adenomas of the stomach. The diagnosis was made using a bite biopsy technique in each case. On histological examination it was found that 34% of the totally resected specimens contained focal cancer. Endoscopic features, such as shape, surface texture and color, were not useful in identifying lesions harboring focal cancer. Nuclear DNA analysis of the biopsy specimens was not useful for differentiating between adenomas and lesions with focal cancer. We therefore recommend total endoscopic resection, as a biopsy, in all patients with a small adenoma of the stomach.     

Indications of Endoscopic Polypectomy for Rectal Carcinoid Tumors and Clinical Usefulness of Endoscopic Ultrasonography

PURPOSE This study was designed to define the indications of endoscopic polypectomy for rectal carcinoid tumors and evaluate the diagnostic value of endoscopic ultrasonography.METHODS A total of 66 rectal carcinoid tumors treated at our hospital were analyzed histopathologically to clarify risk factors for metastasis. The depth of invasion was determined for 52 lesions examined by endoscopic ultrasonography, and the value of endoscopic ultrasonography for deciding whether a lesion is indicated for endoscopic polypectomy was assessed.RESULTS None of the 57 lesions measuring 10 mm in diameter invaded the muscularis propria or had metastasis. Of nine lesions with a diameter of 11 mm, five invaded the muscularis propria and four had metastasis. A central depression was found in three of the lesions with metastasis. The depth of invasion of 49 lesions examined by endoscopic ultrasonography was limited to the submucosa; 3 lesions invaded the muscularis propria. The depth of invasion of all lesions was correctly diagnosed by endoscopic ultrasonography. Ninety-six percent of the lesions that had submucosal invasion with narrowing of the upper two-thirds of the third layer (submucosa) as evaluated by endoscopic ultrasonography could be completely resected by endoscopic polypectomy.CONCLUSIONS Rectal carcinoid tumors that satisfy the following three conditions are indicated for local resection, including endoscopic polypectomy: a maximum diameter of 10 mm, no invasion of the muscularis propria, and no depression or ulceration in the lesion. Endoscopic ultrasonography also is useful for estimating the depth of invasion of rectal carcinoid tumors and for determining whether endoscopic polypectomy is indicated.Published online: 28 January 2005.Reprints are not available.     

Endoscopic Mucosal Resection of Adenocarcinoma at the Minor Duodenal Papilla: A Case Report and Suggestions for the Optimal Treatment Strategy

We herein report an extremely rare case of adenocarcinoma of the minor duodenal papilla (MiDP) which was successfully treated by endoscopic mucosal resection (EMR). An asymptomatic 84-year-old man underwent upper gastrointestinal endoscopy, which revealed a slightly elevated lesion at the MiDP. The biopsy findings were suggestive of adenocarcinoma. Computed tomography, magnetic resonance images and endoscopic ultrasonography did not reveal pancreatic tumor infiltration nor any apparent distant metastases. Therefore, we treated the lesion using EMR with complete resection. No recurrence or metastasis has been detected at 13 months after EMR. Total resection of the MiDP can thus serve as a relatively safe and simple treatment.     

Endoscopic Treatment of Early Gastric Cancer

Abstract: Successful radical endoscopic treatment of early gastric cancer has recently progressed using chiefly the high frequency electric current method and the laser method. The forms of treatment can be classified into mucosal resection and non mucosal resection. The high frequency electric current method is a typical method for mucosal resection and makes it possible to confirm by pathology the complete curability of the excised and collected lesion, but it has limits in terms of the size of the lesion. Of the high frequency electric current method, there are two chief methods used which are endoscopic polypectomy and strip biopsy or ERHSE. Laser endoscopy is a typical method for non mucosal resection, however it cannot remove the lesion and therefore needs a follow-up study including biopsy after the treatment, it can treat however much larger lesions than the mucosal resection method. Laser endoscopy includes the three main methods of vaporization, photodynamic therapy and laserthermia. Indications for radical treatment of early gastric cancer by endoscopy should be limited to lesions without lymph node metastasis. Radical endoscopic treatment for early gastric cancer has recently become the treatment of choice for lesions, even in patients without surgical risk, because of the decreased quality of life which may follow after surgery. The ratio of radical endoscopic treatment to surgery for early gastric cancer has been increasing yearly. Recent advances in the area are reviewed, here.     

Ampullary Adenoma Treated by Endoscopic Double-Snare Retracting Papillectomy

We report herein improved methods for the safe and successful completion of endoscopic papillectomy (EP). Between January 2008 and November 2011, 12 patients underwent double-snare retracting papillectomy for the treatment of lesions of the major duodenal papilla. The main outcomes were en bloc resection rates, pathological findings, and adverse events. All of the patients (mean age, 60.1 years; range, 38 to 80 years) were diagnosed with ampullary adenoma by endoscopic forceps biopsies prior to endoscopic snare papillectomy. En bloc resection by double-snare retracting papillectomy was successfully performed for all lesions (median size, 12.3 mm), comprising six tubular adenomas, one tubulovillous adenoma, three cases of epithelial atypia, one hamartomatous polyp, and one case of duodenitis with regenerative change. Significant hemorrhage and pancreatitis were observed in one case after EP. Adenoma recurrence occurred in three patients during follow-up (median, 28.5 months) at a mean interval of 2 months postoperatively (range, 1 to 3 months). No serious adverse events were observed. Double-snare retracting papillectomy is effective and feasible for treating lesions of the major duodenal papilla. Further treatment experience, including a single-arm phase II study, needs to be accumulated before conducting a randomized controlled study.     

Endoscopic Features of Duodenal Metastases from Breast Cancer

Abstract: The endoscopic appearance of gastrointestinal metastasis from breast cancer is demonstrated in this report. A patient with breast cancer was found by panendoscope examination to have duodenal metastases. The endoscopic characteristic was that of multiple umbilicated submucosal tumors in the bulb and second portion of the duodenum. The imprint cytology of duodenal biopsy specimens, which revealed malignant cells identical to those found in the breast lump aspiration previously, supported the initial endoscopic diagnosis of metastatic breast cancer. The histology of these lesions subsequently revealed many tumor emboli in the mucosal and submucosal lymphatic channels. A laparotomy conducted to perform an intestinal bypass disclosed a large fixed metastatic tumor in the upper retroperitoneum with extension to the mesentery, the mesocolon of the transverse colon and the third portion of the duodenum. The findings at laparotomy and the histologic evidence of tumor emboli in the lymphatics of the mucosal and submucosal layers indicated a retrograde lymphatic spread of the tumor from the large retroperitoneal mass to the duodenal wall. A literature review in this report discusses the differential diagnosis from metastatic disease to second primary malignancy and benign disease of the gastrointestinal system.     

Borderline cases between benignancy and malignancy of the duodenum diagnosed successfully by endoscopic submucosal dissection

Abstract

Objective. Due to advances in endoscopic equipment, primary duodenal tumors are found more frequently than in the past. We performed endoscopic submucosal dissection (ESD) to diagnose and treat four non-ampullary duodenal tumors. Material and methods. During endoscopic treatment, marks were placed around the circumference of the tumor and sufficient amounts of physiological saline with epinephrine were injected into the submucosal layer to elevate the lesion. An incision was made around the lesion using a long-type needle knife and the isolated lesion was resected completely “en bloc”. In this procedure, a cylindrical transparent hood was attached to the endoscopy apparatus to allow for satisfactory visualization of the procedure. Results. The mean age of the patients was 69 years. The patients consisted of two males and two females. Gross examination showed three flat, elevated lesions and one polypoid lesion. Tumor size ranged from 10 to 31 mm in maximum diameter. Histological examination revealed two cases of well-differentiated adenocarcinomas and two cases of tubular adenomas with severe atypia. Procedure-related complications consisting of perforation occurred in two cases and were resolved under close postoperative observation including antibiotics, use of a nasogastric tube and nil per oral feeding status. The mean follow-up period was 18 months and none of the patients experienced tumor recurrence after the treatment. Conclusions. Since tissue obtained from endoscopic biopsies can sometimes prove difficult for definitive histological diagnosis, ESD may play an important role in the management of cases appearing to border on malignancy. In addition, ESD allows for minimally invasive treatment without sacrificing the possibility of cure for duodenal carcinoma.     

Endoscopic mucosal resection of non-ampullary sporadic duodenal adenomas: a retrospective analysis with long-term follow-up

Objective: We investigate the efficiency of endoscopic mucosal resection (EMR) of non-ampullary sporadic duodenal adenomas (NASDA) in a retrospective analysis with long-term follow-up.

Methods: Consecutive patients undergoing EMR of NASDA between May 2002 and December 2016 were retrospectively identified from an electronic database. Endoscopic follow-up was scheduled after 3, 6 and 12 months for the first year, then yearly for up to five years.

Results: EMR of 75 NASDA was performed in 68 patients (56% en-bloc, 44% piecemeal). Retroperitoneal perforations occurred in 3/68 (4.4%) patients, were treated by surgical (n?=?2) or percutaneous (n?=?1) drainage; delayed bleeding was reported in 13/75 (17.3%) resections and was successfully managed by endoscopy (n?=?12) or radiologic embolization (n?=?1). There was no procedure-related mortality. Follow-up was available in 61/68 patients (89.7%) after a median time of 59 months from resection. Residual and recurrent adenoma were diagnosed in 9 (14.5%) and 6 (10.9%) cases, respectively; all but one were successfully retreated endoscopically.

Conclusions: EMR for NASDA is effective with a favorable long-term outcome. Local recurrences can be retreated endoscopically. A recall system, patient’s compliance to endoscopic follow-up are mandatory to detect recurrences and their prompt treatment.