The saline-immersion/irrigation technique (SITE) for endoscopic submucosal dissection for the management of Ileocecal valve (ICV) lesions

Aims Lesions involving the ileocecal valve (ICV) pose unique challenges during endoscopic submucosal dissection (ESD) owing to its complex anatomy and the potential for deeper invasion. Previous studies have suggested that ICV lesions are associated with lower rates of complete (R0) resection and higher recurrence rates in comparison to lesions in other colorectal locations. The aim of the current study was to evaluate the impact of ICV involvement on ESD outcomes, including R0 resection rates, safety and overall procedural success.

Methods We retrospectively reviewed our centre’s prospectively compiled ESD database since 2018. All patients who underwent ESD for right colon lesions were included. The saline-immersion/irrigation technique (SITE) was used in all cases. Baseline patient characteristics, as well as histological and endoscopic parameters, were recorded. R0 resection rates and complication rates were compared between the two groups. Logistic regression analysis was performed to evaluate whether ICV involvement independently affected the likelihood of achieving R0 resection. Procedures abandoned due to suspected deep-invasion identified intra-procedurally, were not included in our analysis [1] [2].

Results A total of 49 patients were included in our study. 42 had lesions confined to the right colon without ICV involvement and 7 had lesions involving the ICV, with 2 of them extending into the terminal ileum. Baseline characteristics did not differ significantly between the groups. The overall R0 resection rate was 87.8%, with no significant differences between right colon lesions with no ICV involvement (88.1%) and lesions involving the ICV (85.7%). Immediate and delayed complication rates were also comparable between the groups. Logistic regression analysis demonstrated that ICV involvement did not significantly decrease the odds of achieving R0 resection (OR: 0.81; 95% CI: 0.08–8.2; p=0.86). However, the wide confidence interval reflects uncertainty due to the small sample size.

Conclusions Despite concerns regarding the anatomical complexity of ICV lesions, this study found no significant impact of ICV involvement on R0 resection rates of right colon lesions. These findings suggest that SITE-facilitated ESD can be an effective and safe organ-preserving approach for en-bloc resection of right colon lesions involving the ICV. However, the small sample size limits definitive conclusions, and further studies are needed to confirm these results and assess long-term outcomes, including recurrence rates.

Publication History

Article published online:
27 March 2025

• References

• 1 Despott EJ, Murino A.. Saline-immersion therapeutic endoscopy (SITE): An evolution of underwater endoscopic lesion resection. Dig Liver Dis 2017; 49 (12): 1376
• 2 Yoshizaki T, Toyonaga T, Tanaka S, Ohara Y, Kawara F, Baba S, Tsubouchi E, Takihara H, Watanabe D, Ishida T, Hoshi N, Morita Y, Umegaki E, Azuma T.. Feasibility and safety of endoscopic submucosal dissection for lesions involving the ileocecal valve. Endoscopy 2016; 48 (07): 639-45 Epub 2016 Mar 18. PMID: 26990510.