CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(03): E241-E246
DOI: 10.1055/a-1068-2161
Original article
Owner and Copyright © Georg Thieme Verlag KG 2020

Efficacy and safety of cap-assisted endoscopic mucosal resection of ileocecal valve polyps

Daniel Lew
1  Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, United States
,
Amir Kashani
2  Division of Gastroenterology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Simon K. Lo
1  Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, United States
,
Laith H. Jamil
3  Section of Gastroenterology and Hepatology, Beaumont Health-Royal Oak, Royal Oak, MI
› Author Affiliations
Further Information

Publication History

submitted 24 July 2019

accepted after revision 30 September 2019

Publication Date:
21 February 2020 (online)

Abstract

Background and study aims Standard endoscopic mucosal resection (EMR) of ileocecal valve (ICV) polyps is challenging. Cap-assisted endoscopic mucosal resection (C-EMR) can be performed when polyps are not easily amenable to standard EMR. Current literature is limited regarding its efficacy and safety for ICV polyps. The objectives of this study were to assess the efficacy and safety of C-EMR for ICV polyps.

Patients and methods A retrospective review was conducted from September 2008 to November 2018 at a tertiary care center. Patients included in the study underwent C-EMR for ICV polyps by a single gastroenterologist (LHJ). Polyps were successfully eradicated if they were removed en-bloc as confirmed by pathology, or had a negative biopsy on follow-up colonoscopy. Outcomes of the procedures were evaluated, including complete adenoma clearance and adverse events.

Results Twenty-one ICV polyps were removed with C-EMR. Median polyp size was 15 mm (range, 5–45). The rate of complete adenoma clearance was 100 %. Procedure-related complications occurred in five patients (24 %): delayed GI bleeding (4.8 %) and deep mucosal resection/visible vessel (14.3 %). Three patients had subsequent surveillance colonoscopies at 8, 56, and 67 months, respectively. The third patient was found to have a 6-mm flat polyp at the edge of the previous polypectomy site. This was treated with C-EMR and repeat colonoscopy 6 months later did not show residual.

Conclusion C-EMR is highly effective in treating ICV polyps with a low complication rate. It is our suggested method in approaching ICV polyps that are difficult to remove via standard freehand snare EMR technique.