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Endoscopy 2022; 54(10): E548-E549
DOI: 10.1055/a-1677-3802
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Endoscopic submucosal dissection with double-endoscope and snare-based traction for adenoma involving the ileocecal valve

Chu-Kuang Chou
1   Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
2   Clinical Trial Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
,
Kun-Feng Tsai
3   Division of Gastroenterology and Hepatology, An Nan Hospital, China Medical University, Tainan, Taiwan
,
Li-Chun Chang
4   Internal Medicine, National Taiwan University Hospital, Taiwan
,
Chao-Wen Hsu
5   Division of Colorectal Surgery, Kaohsiung Veteran General Hospital, Kaohsiung, Taiwan
6   School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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A 2.7-cm lateral spreading tumor involved the ileocecal valve. Most of the lesion was in the terminal ileum and was very hard to approach colonoscopically ([Fig. 1], [Fig. 2]). Performing endoscopic submucosal dissection (ESD) without any additional traction would have been very demanding. The idea of double-endoscope-assisted ESD (DS-ESD) has been proposed for treatment of tumors in the cecum and distal colon [1] [2]. We used double endoscopes, one for ESD and one for traction, to pull the lesion out of the terminal ileum and resect it. We modified DS-ESD with snare-based traction, which was strong and reliable ([Fig. 3], [Fig. 4]). The traction can be adjusted during the procedure. Only around 30 minutes was required to resect this lesion ([Fig. 5]). ESD with double endoscopes and snare-based traction can make lesions involving the ileocecal valve easier to resect ([Video 1]).

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Fig. 1 View of the lesion in the colon.
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Fig. 2 View of the lesion in the terminal ileum.
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Fig. 3 Good separation of mucosa and muscle with the aid of the traction.
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Fig. 4 The lesion was pulled out into the colon and the margin of the terminal ileum side can be clearly seen.
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Fig. 5 The final wound after double-endoscope-assisted endoscopic submucosal dissection.

Video 1 Endoscopic submucosal dissection with double endoscopes and snare-based traction for a flat lesion involving the ileocecal valve. Source for graphical illustration: Chu-kuang Chou, Chiayi Christian Hospital, Taiwan.


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Publication History

Article published online:
15 November 2021

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  • References

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