Ileocecal Valve Lesions No Longer Defy Endoscopic Resection

Ileocecal Valve Lesions No Longer Defy Endoscopic Resection

Douglas K. Rex, MD, MASGE, reviewing Vosko S, et al. Gastrointest Endosc 2021 May 10.

Laterally spreading lesions on the ileocecal valve (ICV) have traditionally been among the most challenging to resect endoscopically, and some centers refer them for surgical resection if they are very large, completely encircling the valve, or penetrating the ileal lumen.

Over a 12-year period ending in October 2020, a consortium of Australian investigators removed 142 laterally spreading ICV lesions 20 mm or larger in size. They divided these lesions into a historical cohort of 76 lesions and a contemporary cohort of 66 lesions. 

The resections in the contemporary cohort versus the historical cohort had a higher success rate (94% vs 78%, respectively), were shorter in duration (40 vs 60 minutes, respectively), and had a lower recurrence rate (4.6% vs 21%, respectively). Snare tip soft coagulation treatment of the colonic side of the EMR margin after resection was used for nearly all of the contemporary cohort versus 6% of the historical controls.

Douglas K. Rex, MD, FASGE

COMMENT

This study shows that benign laterally spreading lesions on the ICV no longer defy endoscopic resection, regardless of their position or morphology. A distal cap attachment on the colonoscope has been, in my experience, one of the most useful tools for the resection of ICV lesions. It was used in some cases in this series but not systematically recorded. The key message is to refer large and complex benign laterally spreading lesions on the ICV for endoscopic rather than surgical resection.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Vosko S, Gupta S, Shahidi N, et al. Impact of technical innovations in endoscopic mucosal resection in the treatment of large nonpedunculated polyps involving the ileocecal valve (with video). Gastrointest Endosc 2021 May 10. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2021.05.011)

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