ESD OF LST-NG TYPE WITH UNDERLYING SUBMUCOSAL TUMOR

Introduction:

Colonic lipomas are benign submucosal lesions which exceptionally may associate with colonic neoplasia or adenoma. LST-NG pseudo-depressed type over 2 cm commonly require en-bloc resection with ESD or other alternative techniques.

Procedure:

A 69 y/o woman was diagnosed with an 40 mm LST-NG PD in ascending colon with no apparent associated lesions, and thus scheduled for ESD. Initial approach to the lesion showed a sessile pseudo-depressed area in proximal section of the lesion. Colonic diverticulum was ruled out after submucosal injection, and ESD was initiated. A pediatric colonoscope (PCF-H190L; Olympus Co.) and Flush Knife^â BT 1.5 mm (Fujifilm Co.) were used.

Results:

A complete en-bloc resection of the LST-NG lesion together with underlying submucosal yellowish tumor was achieved in a single specimen of 60 × 40 mm. Preventive closure of the mucosal defect was completed using TTS clips. The patient was discharged 48h later. Pathology examination showed 40 × 31 mm tubular adenoma with free lateral and deep margins (R0), including an underlying 20 × 15 mm lipoma.

Conclusions:

Underlying lipoma in LST lesions may not be noticed, or it can mimic a diverticulum. Although this circumstance makes ESD more demanding, this technique allows safe and successful en-bloc removal of such complex lesions.