Clinical Presentation, Diagnostic Approach, and Management of Symptomatic Gastrointestinal Lipomas

Abstract

Gastrointestinal (GI) lipomas are a rare form of benign submucosal neoplasm composed of mature adipose tissue. These lesions can grow anywhere in the GI tract, with a higher prevalence observed in the colon and the small intestines. Owing to their relative rarity and asymptomatic nature, the true incidence and prevalence remain unknown. GI lipomas can present with dysphagia, abdominal pain, intestinal obstruction, or GI bleeding, prompting further workup and interventions. On computed tomography and magnetic resonance imaging, GI lipomas typically appear as ovoid/spherical, sharply demarcated, and homogeneously hypodense lesions. On endoscopy, lipomas appear as smooth mucosal protrusions and, rarely, with ulceration. In some cases, an endoscopic ultrasound may be used to confirm diagnosis, staging, or pre-operative planning. Asymptomatic lipomas are managed conservatively using periodic imaging or endoscopy. Symptomatic lipomas, however, require endoscopic or surgical resection, and endoscopic techniques are preferred because of their non-invasive nature. Surgery is typically reserved for giant lipomas or more complex cases. There is a paucity of data regarding the clinical features and management of symptomatic GI lipomas. The current evidence is retrospective, in the form of case reports and conference abstracts. In this review, we discuss the clinical presentation, diagnostic approach, and management of symptomatic GI lipomas.