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Obscure gastrointestinal bleeding from a large jejunal lipoma treated using an endoscopic unroofing technique with double balloon enteroscopy: a case study

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Abstract

Small intestinal lipomas are rare, but may cause obscure gastrointestinal bleeding. The endoscopic unroofing technique excises only the upper third of the lipoma and allows both histological confirmation and complete treatment with minimal risk of perforation. We present a rare case of obscure gastrointestinal bleeding caused by a jejunal lipoma. A 75-year-old man on antiplatelet therapy presented to our department with melena and anemia. Computed tomography revealed he had a 45-mm jejunal submucosal tumor with fat attenuation. Endoscopic resection using an endoscopic unroofing technique with double balloon enteroscopy was successfully performed. The tumor was confirmed to be a lipoma.

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References

  1. Otani K, Watanabe T, Shimada S, et al. Clinical utility of capsule endoscopy and double-balloon enteroscopy in the management of obscure gastrointestinal bleeding. Digestion. 2018;97:52–8.

    Article  Google Scholar 

  2. Pennazio M, Eisen G, Goldfarb N. ICCE consensus for obscure gastrointestinal bleeding. Endoscopy. 2005;37:1046–50.

    Article  CAS  Google Scholar 

  3. Longstreth GF. Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol. 1997;92:419–24.

    CAS  Google Scholar 

  4. Mayo CW, Pagtaliman RJG, Brown DJ. Lipoma of the alimentary tract. Surgery. 1963;53:598–603.

    CAS  Google Scholar 

  5. Nicholas F, Joshua W, Jordan B, et al. A systematic review of symptomatic small bowel lipomas of the jejunum and ileum. Ann of Med Surg. 2020;58:52–67.

    Article  Google Scholar 

  6. Michel LA, Ballet T, Collard JM, et al. Severe bleeding from submucosal lipoma of the duodenum. J Clin Gastroenterol. 1998;10:541–5.

    Article  Google Scholar 

  7. Sou S, Nomura H, Takaki Y, et al. Hemorrhagic duodenal lipoma managed by endoscopic resection. J Gastroenterol Hepatol. 2006;21:479–81.

    Article  Google Scholar 

  8. Chou JW, Feng CL, Lai HC, et al. Obscure gastrointestinal bleeding caused by small bowel lipoma. Intern Med. 2008;47:1601–3.

    Article  Google Scholar 

  9. Sawada T, Yoshida M, Adachi Y, et al. Small intestinal lipoma causing obscure gastrointestinal bleeding. Intern Med. 2013;52:633–4.

    Article  Google Scholar 

  10. Paul TK, Aytekin S, Lucia CF, et al. Endoscopic mucosal resection of jejunal polyps using double-balloon enteroscopy. GE Port J Gastroenterol. 2015;22:137–42.

    Article  Google Scholar 

  11. Toya Y, Endo M, Orikasa S, et al. Lipoma of the small intestine treated with endoscopic resection. Clin J Gastroenterol. 2014;7:502–5.

    Article  Google Scholar 

  12. Noda H, Ogasawara N, Tamura Y, et al. Successful endoscopic submucosal dissection of a large terminal ileal lipoma. Case Rep Gastroenterol. 2016;10:506–11.

    Article  Google Scholar 

  13. Siddharth BJ, Shashideep S. Endoscopic resection of small-bowel submucosal nodule. Endoscopy Georg Thieme Verlag KG. 2016;48:111–111.

    Google Scholar 

  14. Morimoto T, Kuang F, Konuma H, et al. Peeling a giant ileal lipoma with endoscopic unroofing and submucosal disection. World J Gastroenterol. 2010;16:1676–9.

    Article  Google Scholar 

  15. Mimura T, Kuramoto S, Hashimoto M, et al. Unroofing for lymphangiom of the large intestine: a new approach to endoscopic treatment. Gastrointest Endosc. 1997;46:259–63.

    Article  CAS  Google Scholar 

  16. Hizawa K, Kawasaki M, Kouzuki T, et al. Unroofing technique for the endoscopic resection of a large duodenal lipoma. Gastrointest Endosc. 1999;49:391–2.

    Article  CAS  Google Scholar 

  17. Lei S, Yuanshun Z, Wen L. Endoscopic resection of a giant colonic lipoma with endoloop-assisted unroofing technique. Medicine. 2018;97: e10995.

    Article  Google Scholar 

  18. Soares JB, Gonçalves R, Rolanda C. Endoscopic resection of a large colonic lipoma by unroofing technique. Endoscopy. 2011;43:407.

    Article  Google Scholar 

  19. Ana P, Roland P, Sílvio V, et al. Resection of a large ileal lipoma exhibiting ball valve prolapse into the cecum with a ‘“grasp-to-retract, ligate, unroof, and let-go”’ technique. Endoscopy. 2015;47:215–6.

    Article  Google Scholar 

  20. Kwang JL, Gwang HK, Do YP, et al. Endoscopic resection of gastrointestinal lipomas: a single-center experience. Surg Endosc. 2014;28:185–92.

    Article  Google Scholar 

  21. Amol A, Yen-I C, Majidah B, et al. Endoscopic resection of gastric lipoma with a hybrid technique of unroofing and loop ligation. Video GIE. 2017;2:172–3.

    Article  Google Scholar 

  22. Yamamoto K, Ikeya T, Shiratori Y. Endoscopic unroofing and mucosal resection for a large colonic lipoma with intussusception: an effective hybrid technique. VIDEO GIE. 2021;6:190–2.

    Article  Google Scholar 

  23. Tomiki Y, Niwa K, Nagayasu K, et al. Two patients with large colonic lipomas for which endoscopic unroofing was ineffective. Case Rep Gastroenterol. 2016;10:538–44.

    Article  Google Scholar 

  24. Sugimoto K, Sato K, Maekawa H, et al. Unroofing technique for endoscopic resection of a large colonic lipoma. Case Rep Gastroenterol. 2012;6:557–62.

    Article  Google Scholar 

  25. Gun WK, Chang-II K, Sang HS, et al. Endoscopic resection of giant colonic lipoma: case series with partial resection. Clin Endosc. 2013;46:586–90.

    Article  Google Scholar 

  26. Pang Y, Zhang BY, Wang T, et al. Unroofing and grasp-and-snare techniques in the management of a large, duodenal lipoma by duodenoscope combined with a double-channel endoscope. Gastrointest Endosc. 2014;79:27.

    Article  Google Scholar 

  27. Huang WH, Peng CY, Yu CJ, et al. Endoloop-assisted unroofing for the treatment of symptomatic duodenal lipomas. Gastrointest Endosc. 2008;68:1234–6.

    Article  Google Scholar 

  28. Khurelbaatar T, Sakamoto H, Yano T, et al. Endoscopic ischemic polypectomy for small-bowel polyps in patients with Peutz-Jeghers syndrome. Endoscopy. 2021;53:744–8.

    Article  Google Scholar 

Download references

Acknowledgements

We are grateful to our patient, who cooperated with the publication of this report. We would like to thank Editage (www.editage.jp) for English language editing. Authors declare no conflicts of interest for this article.

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Authors and Affiliations

  1. Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, 465 Kajiicho Kamigyo-Ku, Kyoto, 602-8566, Japan

    Reo Kobayashi, Ken Inoue, Ryohei Hirose, Toshifumi Doi, Akihito Harusato, Osamu Dohi, Naohisa Yoshida, Kazuhiko Uchiyama, Takeshi Ishikawa, Tomohisa Takagi, Hiroaki Yasuda, Hideyuki Konishi & Yoshito Itoh

  2. Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Yukiko Morinaga

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  1. Reo Kobayashi
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Correspondence to Ken Inoue.

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When submitting a manuscript to the Clinical Journal of Gastroenterology, all authors are required to disclose any financial relationship (within the last 3 years) with a biotechnology manufacturer, a pharmaceutical company, or other commercial entity that has an interest in the subject matter or materials discussed in the manuscript. The matters requiring disclosure are outlined in the JSGE Conflict of Interest Policy.

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Supplementary file1 Supplementary Video 1. Procedure of an Endoscopic Unroofing Technique with Double balloon Enteroscopy. (MPG 9656 KB)

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Kobayashi, R., Inoue, K., Hirose, R. et al. Obscure gastrointestinal bleeding from a large jejunal lipoma treated using an endoscopic unroofing technique with double balloon enteroscopy: a case study. Clin J Gastroenterol 16, 32–38 (2023). https://doi.org/10.1007/s12328-022-01724-3

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  • DOI: https://doi.org/10.1007/s12328-022-01724-3

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