Tailoring the Management of Colonic Lipomas: A 10-Year Experience of Surgical and Endoscopic Resection

<b>Introduction:</b> Colonic lipomas (CLs) are benign neoplasms originating from adipose tissue within the gastrointestinal tract. They are often asymptomatic, but in certain cases, patients may present with gastrointestinal bleeding or symptoms related to intestinal obstruction. We report the cases of 18 patients undergoing both surgical and endoscopic resection of colonic lipomas. Given the variability in symptoms, lesion size, and patient demographics, the management of CLs represents a clinical scenario where treatment must be tailored to the individual, aligning with the principles of personalized medicine. This study aims to clarify the clinical and morphological factors guiding treatment selection for colonic lipomas, emphasizing a personalized approach to management. <b>Materials and Methods:</b> We retrospectively reviewed a prospectively collected database of 18 patients with histological diagnosis of colon lipoma after both endoscopic and surgical resection at the Campus Bio-Medico University Hospital, Rome, from 2016 to the first months of 2025. <b>Results:</b> The average patient age was 66 years, and the average maximum size of lipoma was 2.87 cm. The anatomical location of lipomas is very varied, ranging from the ileocecal valve to the distal sigma, and most procedures were endoscopic. <b>Conclusions:</b> Despite the fact that no established guidelines about the management of the CLs are reported in literature, the different approaches are related to symptomatology. Our findings try to clarify and demonstrate how the therapeutic decision, whether endoscopic or surgical, is personalized based on the patients and their clinical condition, illustrating how CL management reflects the broader framework of personalized medicine. Our work confirms that the patients most prone to intussusception phenomena are young women with large colonic lipomas.