Balloon-assisted endoscopic submucosal dissection for treating small intestinal lipomas: Report of two cases

Abstract

Background: Most small intestinal lipomas are treated surgically, and some require repeated surgeries for multiple lipomas. However, application of endoscopic submucosal dissection (ESD) technology in the deep small intestine is rarely reported owing to the special anatomical structure of the small intestine, medical equipment limitations, and the lack of relevant experience among endoscopists.

Case summary: Two patients with small intestinal lipomas treated at the Air Force Medical Center from November 2015 to September 2019 were selected to undergo balloon-assisted ESD to treat the lipomas and explore the technical feasibility and safety of ESD for treating small intestinal lipomas. The two patients successfully underwent balloon-assisted ESD to treat four small intestinal lipomas, with a complete resection rate of 100% (4/4), without intraoperative or postoperative bleeding, perforation, or other complications. After 3-6 mo of postoperative follow-up, the clinical symptoms caused by the lipomas were significantly relieved or disappeared after treatment.

Conclusion: Balloon-assisted ESD is a safe and reliable new method for treating deep intestinal lipomas and shows good clinical feasibility.

Keywords: Balloon-assisted endoscopy; Case report; Endoscopic submucosal dissection; Gastrointestinal tumor; Small intestinal lipoma.

Figure 1

Endoscopic submucosal dissection treatment of a terminal ileal lipoma. A: Submucosal lipoma at the terminal ileum; B: Dual knife cut of approximately 1 cm transversely at the anal side of the tumor; C-E: Submucosal lipoma revealed; F: Wound surface after endoscopic submucosal dissection; G: Mucosa covered the wound surface after removing the tumor; H: The wound surface was closed with metal clips; I: Tumor in vitro.

Figure 2

First endoscopic submucosal dissection treatment for lipoma in November 2012. A: Jejunal lipoma with a smooth mucosal surface, occupying 2/3 of the lumen; B: Good lifting via submucosal injection; C: Dual knife cut in an arc along the bottom of the tumor; D: The tumor was located in the submucosa during the dissection; E and F: Dissociated submucosal tumor; G: Wound surface after dissection; H: Metal clip closing the wound surface; I: Tumor in vitro.