Endoscopy 2016; 48(07): 639-645
DOI: 10.1055/s-0042-102783
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Feasibility and safety of endoscopic submucosal dissection for lesions involving the ileocecal valve

Tetsuya Yoshizaki
1   Department of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
,
Takashi Toyonaga
2   Department of Endoscopy, Kobe University Hospital, Kobe, Japan
3   Department of Endoscopy, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Shinwa Tanaka
2   Department of Endoscopy, Kobe University Hospital, Kobe, Japan
,
Yoshiko Ohara
1   Department of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
,
Fumiaki Kawara
1   Department of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
,
Shinichi Baba
3   Department of Endoscopy, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Eiji Tsubouchi
3   Department of Endoscopy, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Hiroshi Takihara
3   Department of Endoscopy, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Daisuke Watanabe
1   Department of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
,
Tsukasa Ishida
1   Department of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
,
Namiko Hoshi
1   Department of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
,
Yoshinori Morita
1   Department of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
,
Eiji Umegaki
1   Department of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
,
Takeshi Azuma
1   Department of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
› Author Affiliations
Further Information

Publication History

submitted 26 August 2015

accepted after revision 19 January 2016

Publication Date:
18 March 2016 (online)

Background and study aim: Endoscopic submucosal dissection (ESD) has been applied to treat early colorectal cancers. The aim of this study was to clarify the clinical course of ESD for lesions involving the ileocecal valve (ICV) by evaluating the successful resection rates, and the risk and frequency of adverse events.

Patients and methods: The outcome of ESD on 38 ICV lesions was compared with the outcome of 132 cecal lesions that did not involve the ICV or appendiceal orifice during the same study period. The factors related to longer procedure time, postoperative stricture development, and tumor recurrence were investigated for ESD of ICV lesions.

Results: There was no significant difference between the ICV and non-ICV groups in the en block resection rates. The median procedure time was significantly longer in the ICV group than in the non-ICV group, with a point estimate of the difference of 37 minutes (95 % confidence interval [CI] 20.00 to 56.00; P  < 0.01). None of the patients developed symptomatic post-ESD stricture or tumor recurrence. ESD procedure duration was ≥ 120 minutes in 16 lesions and < 120 minutes in 22 lesions of the ICV group. A specimen diameter of ≥ 40 mm and tumor extension into terminal ileum were factors related to a longer procedure time (odds ratio [OR] 8.40, 95 %CI 1.53 to 46.10, P = 0.01; OR 10.60, 95 %CI 2.17 to 51.40, P  < 0.01, respectively).

Conclusions: ICV lesions can be resected by ESD without major adverse events or causing symptomatic stricture development. However, ESD for ICV lesions should be performed only by expert endoscopists, as the procedure requires accomplished endoscopic skill and experience.