Endoscopic resection of very large submucosal tumors in the colon is feasible

Introduction: Submucosal tumors of the colon are rare and usually incidental findings causing no symptoms. Lesions bigger than 2cm are usually resected surgically if the cause symptoms as endoscopic resection is associated with an elevated risk for perforation. Patient and Method: We report on a 57 year old patient who underwent colonoscopy because of recurrent abdominal pain, intermittent constipation and a positive fecal occult blood test. A large submucosal tumor with a short stalk was found in the ascending colon. Because of the symptoms and the size of the lesion the patient was scheduled for surgery. Due to concomitant diseases like COPD Gold III, hypertension and massive obesity the patient was regarded as high risk and colonoscopic resection with surgical stand-by was planned. Because of the huge size, placement of an Endo-Loop® (Olympus Corp.) was not possible. The tumor was therefore resected using a Jumbo Captivator Snare® (Boston Scientific). The area of resection was closed using six Resolution Clips® (Boston Scientific). No complication occurred and the patient was discharged the next day. Results: The resected specimen measured 5.5cm in diameter. Histopathological work-up revealed a lipoma, resected completely and in one piece. Discussion: Only five cases of endoscopic resection of submucosal tumors measuring 5cm or more in diameter have been published so far. Perforation occurred once in a sessile lesion. Endoscopic removal of very large submucosal tumors is feasible and seems to be reasonably save even without prior placement of an Endo-Loop®. However, interdisciplinary management of such cases is mandatory in order to maximize patient's safety and to deal with potential complications like perforation or hemorrhage. Endoscopic resection of very large submucosal tumors seems to be a viable treatment option for symptomatic patients unfit for surgery.