Endoloop ligation of large pedunculated submucosal tumors (with videos).
BACKGROUND
Endoscopic treatment of a pedunculated submucosal tumor (SMT) has not been well established. In particular, endoscopic cautery snare resection of a large pedunculated SMT is discouraged because of the increased risk of bowel perforation.


OBJECTIVE
To report the clinical outcome of endoloop ligation for the treatment of various pedunculated SMTs with a clip-marking technique.


METHODS
Prospective evaluation of 10 patients who, between June 2005 and May 2006, received endoloop ligation with a clip-marking technique.


METHODS
At a tertiary-care, academic medical center.


METHODS
Ten patients with various pedunculated SMTs with either symptomatic lesions or large-sized lesions (>4 cm).


METHODS
Clinical procedural success, reported adverse events.


RESULTS
Nine cases were successfully treated, with tumor removal within 4 weeks. In contrast, only 1 patient needed a second session of loop ligation. Only 6 specimens were retrieved. There were no procedure-related complications, such as bleeding or perforation.


CONCLUSIONS
Retrieval by the patient of a specimen from stool was possible in only 60% of cases; a limited number of 10 patients; by oncology standards, not the correct treatment for nonlipomatous lesions, which limits its application to surgical risk candidates.


CONCLUSIONS
Endoloop ligation of large pedunculated SMTs seemed to be technically feasible and appeared to be safe in this case series. Further controlled clinical trials have to be conducted before application of this technique to a large submucosal lipoma or other SMTs in surgical high-risk candidates can be generally recommended.
Lee
Suck-Ho
SH
Department of Internal Medicine, Soon Chun Hyang University Cheonan Hospital, Cheonan, Korea.
Park
Jeong-Hoon
JH
Park
Do Hyun
DH
Chung
Il-Kwun
IK
Kim
Hong-Soo
HS
Park
Sang-Heum
SH
Kim
Sun-Joo
SJ
Cho
Hyun-Deuk
HD
D000328:Adult; D000368:Aged; D004564:Electrocoagulation; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008026:Ligation / Q000379:methods; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane; D011446:Prospective Studies; D016896:Treatment Outcome