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A 51-year-old woman was referred to our department for endoscopic resection of a symptomatic ileal lipoma, which had been detected during a previous colonoscopy performed to investigate a 6-month historyof intermittent episodes of abdominal pain and diarrhea. Colonoscopy revealed a large, yellowish, pseudo-pedunculated ileal lesion with normal overlying mucosa that was prolapsed through the ileocecal valve into the cecum (●" Fig.1). Because of retraction of the lipoma into the terminal ileum with manipulation (●" Fig.2,●" Video 1), a two-channel therapeutic colonoscope (CF-2T160I; Olympus America, Center Valley, Pennsylvania, USA) was used. The lipoma was pulled toward the ascending colon with a grasping forceps while an endoloop (MAJ-254; Olympus), previously placed over the forceps, was positioned and tightened around its base (●" Fig.3,●" Video 1). Endoloop ligation resulted in congestion of the mucosa and the extrusion of fat – the “naked fat” sign (●" Fig.4,●" Video 1). Subsequently, unroofing was accomplished by snare resection of the top of the tumor (●" Fig.5,●" Video 1), histopathologic examination of which confirmed the clinical diagnosis. At follow-up colonoscopy 2 months later, the patient was asymptomatic, and a scar with no residual lesion was found (●" Fig. 6). Lipomas account for 21.4% of all benign small-bowel tumors and are located Fig.3 Endoscopic image depicting the use of a grasping forceps to pull the lipoma toward the ascending colon, allowing placement of the endoloop. Fig.1 Endoscopic image of an ileal submucosal lesion with a normal overlying mucosa. The lesion has prolapsed through the ileocecal valve into the cecum. Fig.2 Endoscopic image showing retraction of the lipoma into the terminal ileum.

Resection of a large ileal lipoma exhibiting ball-valve prolapse into the cecum with a “grasp-to-retract, ligate, unroof, and let-go” technique