Subscribe to RSS
Endoscopic submucosal dissection with a scissors-type knife for colonic lipoma
Endoscopic resection for large colonic tumors can be difficult as snaring for endoscopic mucosal resection may be challenging and the entire lesion may be difficult to visualize, increasing perforation risk . On the other hand, reports of successful endoscopic submucosal dissection (ESD) for colonic submucosal tumors are increasing . Scissors-type knives have an enhanced ability to grasp tissue layers selectively, rotate the knife, and achieve hemostasis . We report successful use of the scissors-type knife SB Knife Jr 2 (Sumitomo Bakelite, Tokyo, Japan) in ESD of a large, pedunculated colonic lipoma.
A 75-year-old man presented with abdominal distention. Computed tomography (CT) confirmed a hypodense, clearly delineated mass measuring 5 cm in the sigmoid colon ([Fig. 1a]). CT colonography suggested a potentially obstructive mass, but no proximal dilation was observed ([Fig. 1b]).
A large, pedunculated lesion was observed in the sigmoid colon ([Fig. 2a], [Fig. 2b]). The spastic colon and the patient’s inability to stay still made it difficult to maintain scope position or endoscopic view. Because an endoloop could not be placed, ESD was performed using an SB Knife Jr 2 ([Video 1]). When a lifting solution containing indigo carmine was injected into the submucosa, the color change clearly marked the end of the tumor ([Fig. 2c]). Circumferential mucosal incision and subsequent submucosal dissection were performed with minimal bleeding, and en bloc resection was achieved ([Fig. 2d], [Fig. 2e], [Fig. 2f]). Pathology confirmed complete resection of a colonic lipoma ([Fig. 3]).
Video 1 Endoscopic submucosal dissection of a large, pedunculated lipoma in the sigmoid colon using a scissors-type knife.
Use of scissors-type knives has been reported in ESD of pedunculated colonic polyps and small bowel lipomas  . Unlike traditional ESD knives, the scissors-type knife can cut without putting pressure on the stalk, which may cause pedunculated lesions to change position unpredictably. The knife’s ability to grasp and pull allowed for clear visualization of the portion being cut and avoided deep thermal damage, even when the endoscope was perpendicular to the colonic wall. Effective hemostasis was also achieved with one device. The scissors-type knife, therefore, may be a safe option for pedunculated lesions.
17 June 2021 (online)
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Yu HG, Ding YM, Tan S. et al. A safe and efficient strategy for endoscopic resection of large, gastrointestinal lipoma. Surg Endosc 2007; 21: 265-269
- 2 Okada K, Shatari T, Suzuki K. et al. Is endoscopic submucosal dissection really contraindicated for a large submucosal lipoma of the colon?. Endoscopy 2008; 40 (Suppl. 02) E227
- 3 Shiratori Y, Ikeya T, Fukuda K. Introducing the newly developed SB Knife Jr 2: enhancing creative endoscopic submucosal dissection. Endoscopy 2020; DOI: 10.1055/a-1292-4426.
- 4 Jawaid S, Draganov PV, Yang D. Endoscopic resection of large pedunculated colon polyps using only a scissor-type knife: a case series. VideoGIE 2020; 5: 264-266
- 5 Toya Y, Endo M, Orikasa S. et al. Lipoma of the small intestine treated with endoscopic resection. Clin J Gastroenterol 2014; 7: 502-505