Endoscopic submucosal dissection with double-endoscope and snare-based traction for adenoma involving the ileocecal valve

A 2.7-cm lateral spreading tumor involved the ileocecal valve. Most of the lesion was in the terminal ileum and was very hard to approach colonoscopically ([Fig. 1], [Fig. 2]). Performing endoscopic submucosal dissection (ESD) without any additional traction would have been very demanding. The idea of double-endoscope-assisted ESD (DS-ESD) has been proposed for treatment of tumors in the cecum and distal colon [1] [2]. We used double endoscopes, one for ESD and one for traction, to pull the lesion out of the terminal ileum and resect it. We modified DS-ESD with snare-based traction, which was strong and reliable ([Fig. 3], [Fig. 4]). The traction can be adjusted during the procedure. Only around 30 minutes was required to resect this lesion ([Fig. 5]). ESD with double endoscopes and snare-based traction can make lesions involving the ileocecal valve easier to resect ([Video 1]).

Fig. 1 View of the lesion in the colon.

Fig. 2 View of the lesion in the terminal ileum.

Fig. 3 Good separation of mucosa and muscle with the aid of the traction.

Fig. 4 The lesion was pulled out into the colon and the margin of the terminal ileum side can be clearly seen.

Fig. 5 The final wound after double-endoscope-assisted endoscopic submucosal dissection.

Video 1 Endoscopic submucosal dissection with double endoscopes and snare-based traction for a flat lesion involving the ileocecal valve. Source for graphical illustration: Chu-kuang Chou, Chiayi Christian Hospital, Taiwan.

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• References

• 1 Ebigbo A, Tziatzios G, Golder SK. et al. Double-endoscope assisted endoscopic submucosal dissection for treating tumors in rectum and distal colon by expert endoscopists: a feasibility study. Tech Coloproctol 2020; 24: 1293-1299
• 2 Kimura K, Tsujii Y, Saiki H. et al. Double-scope endoscopic submucosal dissection for a laterally spreading cecal tumor. ACG Case Rep J 2019; 6: e00168