Abstract
Background and study aims Ileocecal valve (ICV) lesions are challenging to remove endoscopically.
Patients and methods This was a retrospective cohort study, performed at an academic tertiary US hospital.
Sessile polyps or flat ICV lesions ≥ 20 mm in size referred for endoscopic mucosal
resection (EMR) were included. Successful resection rates, complication rates and
recurrence were compared to lesions ≥ 20 mm in size not located on the ICV.
Results During an 18-year interval, there were 118 ICV lesions ≥ 20 mm with mean size 28.6 mm
(44.9 % females; mean age 71.6 years), comprising 9.03 % of all referred polyps. Ninety
ICV lesions (76.3 %) were resected endoscopically, compared to 91.3 % of non-ICV lesions
(P < 0.001). However, in the most recent 8 years, successful EMR of ICV lesions increased
to 93 %. Conventional adenomas comprised 92.2 % of ICV lesions and 7.8 % were serrated.
Delayed hemorrhage and perforation occurred in 3.3 % and 0 % of ICV lesions, respectively,
compared to 4.8 % and 0.5 % in the non-ICV group. At first follow-up, rates of residual
polyp in the ICV and non-ICV groups were 16.5 % and 13.6 %, respectively (P = 0.485). At second follow-up residual rates in the ICV and non-ICV lesion groups
were 18.6 % and 6.7 %, respectively (P = .005).
Conclusions Large ICV polyps are a common source of tertiary referrals. Over an 18-year experience,
risk of EMR for ICV polyps was numerically lower, and risk of recurrence was numerically
higher at first follow and significantly higher at second follow-up compared to non-ICV
polyps.
