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.
