Are large ileocecal valve lesions amenable with advanced endoscopic management to avoid bowel resection?

Mucosal lesions located at the ileocecal valve may be challenging for endoscopic intervention because of angulated anatomy and a thinner wall with narrower lumen when compared to other locations of the bowel. This study aimed to evaluate the management and outcomes of ileocecal valve lesions treated endoscopically.

Patients with mucosal neoplasms involving the ileocecal valve managed with advanced endoscopy at a quaternary care hospital between 2011 and 2021 were included from a prospectively collected database. Patient demographics, lesion characteristics, complications, and outcomes are reported.

From 1005 lesions, 80 patients (8%) underwent resection for neoplasms involving ileocecal valve by ESD (n = 38), hybrid ESD (n = 38), EMR (n = 2), and CELS (n = 2). The median age of the study group was 63(37-84) years, and 50% of patients were female. The median lesion size was 34 mm (5-75). The mean procedure time was 66 ± 44 min(range:18-200). The dissection was completed as piecemeal in 41(51%) patients and 35(44%) had en-bloc dissection. Seven(8%) endoscopic interventions required conversion to laparoscopic surgery due to inability to lift the mucosa(n = 4) and perforation(n = 3). No immediate bleeding occurred in the study group. Five patients had late rectal bleeding and two were admitted with post-polypectomy pain within 30 days of intervention. Pathology revealed 4(5%) adenocarcinomas, 33(41.2%) tubular adenomas, 30(37.8%) tubulovillous adenomas, and 5(6.2%) sessile serrated adenomas. Sixty-seven (84.5%) patients completed at least one follow-up colonoscopy and were followed for a median of 11(0-64) months. Six (8.9%) patients had recurrence and were managed with subsequent endoscopic removal.

Advanced endoscopy can be safely and effectively performed for the management of ileocecal valve polyps with low complication and acceptable recurrence rates. Advanced endoscopy promises an alternative approach to oncologic ileocecal resection while attaining organ preservation. Our study demonstrates the impact of advanced endoscopy for the treatment of mucosal neoplasms involving ileocecal valve.