Endoloop ligation of large pedunculated submucosal tumors (with videos)

BackgroundEndoscopic 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.ObjectiveTo report the clinical outcome of endoloop ligation for the treatment of various pedunculated SMTs with a clip-marking technique.DesignProspective evaluation of 10 patients who, between June 2005 and May 2006, received endoloop ligation with a clip-marking technique.SettingAt a tertiary-care, academic medical center.PatientsTen patients with various pedunculated SMTs with either symptomatic lesions or large-sized lesions (>4 cm).Main Outcome MeasurementsClinical procedural success, reported adverse events.ResultsNine 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.LimitationsRetrieval 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.ConclusionsEndoloop 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.