1697 The Safety and Efficacy of Endoloop Ligation (“Loop-and-Let-Go”) of a Very Large Jejunal Lipoma

Abstract

INTRODUCTION: Lipomas can occur anywhere throughout the gastrointestinal tract and can range widely in size. When symptomatic, these lipomas require removal, and several techniques have been described depending on the size of the lesion. Recently, a method utilizing an endoloop ligation has been proposed and validated for use in colonic lipomas. However, there remains a lack of literature on the safety and efficacy of endoloop ligation for the removal of symptomatic lipomas in the small intestine. CASE DESCRIPTION/METHODS: A 55-year-old male with a history of neurofibromatosis, prior prostate cancer, and tobacco use presented for evaluation of melena. He underwent an upper endoscopy which was reportedly normal and was transferred to our center for consideration of small bowel endoscopy. He continued to have melena and labile hemoglobin. A push enteroscopy revealed a long, submucosal lesion in the proximal jejunum with several areas of ulceration which were presumed to be the source of his bleeding. The mass was biopsied, and pathology was consistent with a lipoma. Subsequently, the patient underwent EUS and endoloop ligation. A video from this case is submitted to demonstrate the proper use of endoloop ligation of a large lipoma in the small intestine. Following placement of the endoloop ligature, the patient had no further bleeding and a follow-up enteroscopy one month later revealed complete loss of the lipoma with unremarkable appearing mucosa. DISCUSSION: In this case, we demonstrate that endoloop ligation is a safe technique for the removal of symptomatic large lipomas in the small bowel. In the video, we demonstrate how to apply the endoloop ligature to such a lesion effectively. Watch the video: http://bit.ly/2JSdmLE.