Colonoscopy: Sigmoid lipoma loop ligation

A middle aged patient was referred endoscopic resection of a 6 cm pedunculated polyp with a broad stalk. Adult colonoscope was used. A large polyp was observed occluding the lumen. Epinephrine was injected to reduce the size of the polyp; adult colonoscope could not go up by the side of the polyp. An EGD scope fitted with a cap was used to go past the polyp; in the process the polyp flipped up. On endoscope withdrawal, it became apparent that the polyp was infact a giant lipoma with a broad stalk. Biopsy on biopsy confirmed the diagnosis by demonstrating fat. Loop ligation was unsuccessful. A clip attached to dental floss was used to clip the head of lipoma to facilitate loop application; this was unsuccessful. Then on tugging the string, the lipoma flipped down, which facilitated loop ligation. The ligation was applied for 15 minutes before the loop was released. A tattoo was placed to mark the site.