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DOI: 10.1055/s-0043-115002
Management of a rare cause of significant acute upper gastrointestinal bleeding: gastric lipoma resected by hybrid endoscopic submucosal dissection
Corresponding author
Publication History
Publication Date:
18 July 2017 (online)
Gastric lipomas are rare, benign, slow-growing subepithelial tumors. Most lipomas remain asymptomatic and are detected incidentally at endoscopy. Large lipomas, however, may very rarely cause significant upper gastrointestinal (GI) bleeding and warrant removal [1].
For the management of large gastric lipomas, laparoscopic excision may be required, but endoscopic techniques such as endoscopic submucosal dissection (ESD) and unroofing have also been described [1] [2].
This endoscopic video case highlights this rare cause of upper GI bleeding and its definitive management by hybrid ESD.
A 66-year-old man presented with melena, pallor, and fatigue. On admission, his hemoglobin level was 89 g/L. He underwent an upper GI endoscopy during which a 3 cm ulcerated submucosal lesion was identified at the greater curvature ([Fig. 1]). An endoscopic clip and Hemospray (Cook Medical, Winston-Salem, North Carolina, USA) were applied, and hemostasis was achieved.
![](https://www.thieme-connect.de/media/endoscopy/201710/thumbnails/10-1055-s-0043-115002-i0184cl1.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Computed tomography imaging revealed an ovoid (fat-dense) lesion measuring 25 × 15 mm, consistent with a lipoma ([Fig. 2]). Endoscopic ultrasound assessment of the lesion was subsequently performed, and showed the presence of a homogeneous and slightly hyperechoic lesion, 25 × 15 mm, arising from the hyperechoic submucosal layer. A 22 g needle was used to obtain core biopsies but unfortunately the sample was inadequate for diagnostic assessment.
![](https://www.thieme-connect.de/media/endoscopy/201710/thumbnails/10-1055-s-0043-115002-i0184cl2.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Endoscopic management of the lesion was agreed and the lesion was successfully resected by hybrid ESD ([Video 1]). No immediate or delayed adverse events were encountered.
Video 1 Hybrid endoscopic submucosal dissection procedure for the endoscopic management of a gastric lipoma.
Quality:
Histopathology confirmed the diagnosis of submucosal gastric lipoma, which was completely excised ([Fig. 3]). On repeat endoscopy 3 months post-procedure, a well-healed scar was seen at the site of excision.
![](https://www.thieme-connect.de/media/endoscopy/201710/thumbnails/10-1055-s-0043-115002-i0184cl3.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
This video case highlights the role of hybrid ESD in the minimally invasive and definitive management of this rare submucosal cause of upper GI bleeding.
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Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online.
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos
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Competing interests
None
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References
- 1 Lee KJ, Kim GH, Park DY. et al. Endoscopic resection of gastrointestinal lipomas: a single-center experience. Surg Endosc 2014; 28: 185-192
- 2 Matsushita M, Fukata N, Okazaki K. Endoscopic removal of large gastric lipomas: en bloc resection with submucosal dissection or partial resection with unroofing technique?. Dig Endosc 2013; 25: 211-212
Corresponding author
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References
- 1 Lee KJ, Kim GH, Park DY. et al. Endoscopic resection of gastrointestinal lipomas: a single-center experience. Surg Endosc 2014; 28: 185-192
- 2 Matsushita M, Fukata N, Okazaki K. Endoscopic removal of large gastric lipomas: en bloc resection with submucosal dissection or partial resection with unroofing technique?. Dig Endosc 2013; 25: 211-212
![](https://www.thieme-connect.de/media/endoscopy/201710/thumbnails/10-1055-s-0043-115002-i0184cl1.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/201710/thumbnails/10-1055-s-0043-115002-i0184cl2.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/201710/thumbnails/10-1055-s-0043-115002-i0184cl3.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)