Traction-assisted endoscopic submucosal dissection for resection of ileocecal valve neoplasia: a French retrospective multicenter case series

Abstract

Background The ileocecal valve (ICV) is considered to be one of the most difficult locations for endoscopic submucosal dissection (ESD). The objective of this study was to evaluate the efficacy and safety of traction-assisted ESD in this situation.

Methods All patients who underwent traction-assisted ESD for an ICV lesion at three centers were identified from a prospective ESD database. En bloc and R0 rates were evaluated. Factors associated with non-R0 resection were explored.

Results 106 patients with an ICV lesion were included. The median lesion size was 50 mm (interquartile range 38–60) and 58.5% (62/106) invaded the terminal ileum. The en bloc and R0 resection rates were 94.3% and 76.4%, respectively. Factors associated with non-R0 resection were lesions covering ≥75% of the ICV (odds ratio [OR] 0.21. 95%CI 0.06–0.76; P=0.02), and involving the anal lip (OR 0.36, 95%CI 0.13–0.99; P=0.04) or more than two sites on the ICV (OR 0.27, 95%CI 0.07–0.99; P=0.03).

Conclusion Traction-assisted ESD for treatment of ICV lesions was a safe and feasible option. Large lesions and anal lip involvement appeared to be factors predictive of difficulty.

Publication History

Received: 04 September 2023

Accepted after revision: 29 April 2024

Accepted Manuscript online:
29 April 2024

Article published online:
10 June 2024

• References

• 1 Ponugoti PL, Broadley HM, Garcia J. et al. Endoscopic management of large ileocecal valve lesions over an 18-year interval. Endosc Int Open 2019; 7: E1646-E1651 DOI: 10.1055/a-0990-9035. (PMID: 31788547)
• 2 Fleischmann C, Probst A, Ebigbo A. et al. Endoscopic submucosal dissection in Europe: results of 1000 neoplastic lesions from the German Endoscopic Submucosal Dissection Registry. Gastroenterology 2021; 161: 1168-1178
• 3 Fuccio L, Hassan C, Ponchon T. et al. Clinical outcomes after endoscopic submucosal dissection for colorectal neoplasia: a systematic review and meta-analysis. Gastrointest Endosc 2017; 86: 74-86.e17
• 4 Oung B, Rivory J, Chabrun E. et al. ESD with double clips and rubber band traction of neoplastic lesions developed in the appendiceal orifice is effective and safe. Endosc Int Open 2020; 8: E388-E395
• 5 Masgnaux L-J, Grimaldi J, Rostain F. et al. Endoscopic submucosal dissection of appendiceal lesions by using a novel adjustable traction device: A-TRACT-2. VideoGIE 2023; 8: 81-83 DOI: 10.1016/j.vgie.2022.09.008. (PMID: 36820254)
• 6 Grimaldi J, Masgnaux L-J, Wallenhorst T. et al. Endoscopic submucosal dissection of a quasi-circumferential lesion of the ileo-cecal valve by using a novel adjustable traction device. Endoscopy 2023; 55: E574-E575 DOI: 10.1055/a-2051-8765. (PMID: 36996889)
• 7 Ikezawa N, Toyonaga T, Tanaka S. et al. Feasibility and safety of endoscopic submucosal dissection for lesions in proximity to a colonic diverticulum. Clin Endosc 2022; 55: 417-425 DOI: 10.5946/ce.2021.245. (PMID: 35545214)
• 8 Tanaka S, Toyonaga T, Morita Y. et al. Endoscopic submucosal dissection for early gastric cancer in anastomosis site after distal gastrectomy. Gastric Cancer 2014; 17: 371-376 DOI: 10.1007/s10120-013-0283-5. (PMID: 23868403)
• 9 Hotta K, Osera S, Shinoki K. et al. Feasibility of endoscopic submucosal dissection for cecal tumors involving the ileocecal valve or appendiceal orifice. J Gastroenterol Hepatol 2022; 37: 1517-1524 DOI: 10.1111/jgh.15872. (PMID: 35481681)
• 10 Yoshizaki T, Toyonaga T, Tanaka S. et al. Feasibility and safety of endoscopic submucosal dissection for lesions involving the ileocecal valve. Endoscopy 2016; 48: 639-645 DOI: 10.1055/s-0042-102783. (PMID: 26990510)
• 11 Wallenhorst T, Pioche M, Bouguen G. et al. Ileocecal valve opening with double clip and rubber band for countertraction facilitates R0 en bloc resection of laterally spreading tumors. Endoscopy 2020; 52: E390-E391
• 12 Ozgur I, Justiniano CF, Valente MA. et al. Are large ileocecal valve lesions amenable with advanced endoscopic management to avoid bowel resection?. Surg Endosc 2023; 37: 5320-5325
• 13 Suzuki T, Hara T, Kitagawa Y. et al. Feasibility of endoscopic submucosal dissection for cecal lesions. Scand J Gastroenterol 2018; 53: 359-364 DOI: 10.1080/00365521.2018.1430254. (PMID: 29368544)
• 14 Andrisani G, Fukuchi T, Antonelli G. et al. Superficial neoplasia involving the Ileocecal valve: clinical outcomes of endoscopic submucosal dissection. Dig Liver Dis 2021; 53: 889-894 DOI: 10.1016/j.dld.2021.03.005. (PMID: 33762176)
• 15 Nanda K, Tutticci N, Burgess N. et al. Endoscopic mucosal resection of laterally spreading lesions involving the ileocecal valve: technique, risk factors for failure, and outcomes. Endoscopy 2015; 47: 710-718 DOI: 10.1055/s-0034-1391732. (PMID: 25763831)
• 16 Vosko S, Gupta S, Shahidi N. et al. Impact of technical innovations in EMR in the treatment of large nonpedunculated polyps involving the ileocecal valve (with video). Gastrointest Endosc 2021; 94: 959-968.e2
• 17 Rodríguez Sánchez J, Alvarez-Gonzalez MA, Pellisé M. et al. Underwater versus conventional EMR of large nonpedunculated colorectal lesions: a multicenter randomized controlled trial. Gastrointest Endosc 2023; 97: 941-951.e2