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

Tetsuya Yoshizaki; Takashi Toyonaga; Shinwa Tanaka; Yoshiko Ohara; Fumiaki Kawara; Shinichi Baba; Eiji Tsubouchi; Hiroshi Takihara; Daisuke Watanabe; Tsukasa Ishida; Namiko Hoshi; Yoshinori Morita; Eiji Umegaki; Takeshi Azuma

doi:10.1055/s-0042-102783

Endoscopy, Table of Contents

Endoscopy 2016; 48(07): 639-645
DOI: 10.1055/s-0042-102783

Original article

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

Tetsuya Yoshizaki

¹Department of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan

,

Takashi Toyonaga

²Department of Endoscopy, Kobe University Hospital, Kobe, Japan

³Department of Endoscopy, Kishiwada Tokushukai Hospital, Kishiwada, Japan

,

Shinwa Tanaka

²Department of Endoscopy, Kobe University Hospital, Kobe, Japan

,

Yoshiko Ohara

¹Department of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan

,

Fumiaki Kawara

¹Department of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan

,

Shinichi Baba

³Department of Endoscopy, Kishiwada Tokushukai Hospital, Kishiwada, Japan

,

Eiji Tsubouchi

³Department of Endoscopy, Kishiwada Tokushukai Hospital, Kishiwada, Japan

,

Hiroshi Takihara

³Department of Endoscopy, Kishiwada Tokushukai Hospital, Kishiwada, Japan

,

Daisuke Watanabe

¹Department of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan

,

Tsukasa Ishida

¹Department of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan

,

Namiko Hoshi

¹Department of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan

,

Yoshinori Morita

¹Department of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan

,

Eiji Umegaki

¹Department of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan

,

Takeshi Azuma

¹Department of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan

› Author Affiliations

Abstract

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.

Full Text

References

References
1 Iishi H, Tatsuta M, Iseki K et al. Endoscopic piecemeal resection with submucosal saline injection of large sessile colorectal polyps. Gastrointest Endosc 2000; 51: 697-700
2 Terasaki M, Tanaka S, Oka S et al. Clinical outcomes of endoscopic submucosal dissection and endoscopic mucosal resection for laterally spreading tumors larger than 20 mm. J Gastroenterol Hepatol 2012; 27: 734-740
3 Saito Y, Fukuzawa M, Matsuda T et al. Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc 2010; 24: 343-352
4 Toyonaga T, Man-i M, East JE et al. 1,635 Endoscopic submucosal dissection cases in the esophagus, stomach, and colorectum: complication rates and long-term outcomes. Surg Endosc 2013; 27: 1000-1008
5 Saito Y, Otake Y, Sakamoto T et al. Indications for and technical aspects of colorectal endoscopic submucosal dissection. Gut Liver 2013; 7: 263-269
6 Toyonaga T, Nishino E, Man IM et al. Principles of quality controlled endoscopic submucosal dissection with appropriate dissection level and high quality resected specimen. Clin Endosc 2012; 45: 362-374
7 Saito Y, Yamada M, So E et al. Colorectal endoscopic submucosal dissection: technical advantages compared to endoscopic mucosal resection and minimally invasive surgery. Dig Endosc 2014; 26: 52-61
8 Rahmi G, Hotayt B, Chaussade S et al. Endoscopic submucosal dissection for superficial rectal tumors: prospective evaluation in France. Endoscopy 2014; 46: 670-676
9 Yoon JY, Kim JH, Lee JY et al. Clinical outcomes for patients with perforations during endoscopic submucosal dissection of laterally spreading tumors of the colorectum. Surg Endosc 2013; 27: 487-493
10 Thorlacius H, Uedo N, Toth E. Implementation of endoscopic submucosal dissection for early colorectal neoplasms in Sweden. Gastroenterol Res Pract 2013; 2013: 758202
11 Repici A, Hassan C, Pagano N et al. High efficacy of endoscopic submucosal dissection for rectal laterally spreading tumors larger than 3 cm. Gastrointest Endosc 2013; 77: 96-101
12 Kishimoto G, Saito Y, Takisawa H et al. Endoscopic submucosal dissection for large laterally spreading tumors involving the ileocecal valve and terminal ileum. World J Gastroenterol 2012; 18: 291-294
13 Conio M, Blanchi S, Filiberti R et al. Cap-assisted endoscopic mucosal resection of large polyps involving the ileocecal valve. Endoscopy 2010; 42: 677-680
14 Ishii N, Itoh T, Horiki N et al. Endoscopic submucosal dissection with a combination of small-caliber-tip transparent hood and flex knife for large superficial colorectal neoplasias including ileocecal lesions. Surg Endosc 2010; 24: 1941-1947
15 Nanda KS, Tutticci N, Burgess NG et al. Endoscopic mucosal resection of laterally spreading lesions involving the ileocecal valve: technique, risk factors for failure, and outcomes. Endoscopy 2015; 47: 710-718
16 Tanaka S, Kashida H, Saito Y et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 2015; 27: 417-434
17 Toyonaga T, Man-I M, Fujita T et al. The performance of a novel ball-tipped Flush knife for endoscopic submucosal dissection: a case–control study. Aliment Pharmacol Ther 2010; 32: 908-915
18 Tanaka S, Toyonaga T, Morita Y et al. Feasibility and safety of endoscopic submucosal dissection for large colorectal tumors. Surg Laparosc Endosc Percutan Tech 2015; 25: 223-228
19 Arantes V, Toyonaga T, Piñeros E. Polyethylene glycol submucosal irrigation: a novel approach to improve visibility during endoscopic submucosal dissection. Endosc Int Open 2014; 2: E193-E195
20 Tajiri H, Kitano S. Complications associated with endoscopic mucosal resection: definition of bleeding that can be viewed as accidental. Dig Endosc 2004; 16: S134-S136
21 Shafik AA, Ahmed IA, Shafik A et al. Ileocecal junction: anatomic, histologic, radiologic and endoscopic studies with special reference to its antireflux mechanism. Surg Radiol Anat 2011; 33: 249-256
22 Saito Y, Uraoka T, Yamaguchi Y et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc 2010; 72: 1217-1225
23 Oka S, Tanaka S, Saito Y et al. Local recurrence after endoscopic resection for large colorectal neoplasia: a multicenter prospective study in Japan. Am J Gastroenterol 2015; 110: 697-707
24 Hori K, Uraoka T, Harada K et al. Predictive factors for technically difficult endoscopic submucosal dissection in the colorectum. Endoscopy 2014; 46: 862-870
25 Ezoe Y, Muto M, Horimatsu T et al. Efficacy of preventive endoscopic balloon dilation for esophageal stricture after endoscopic resection. J Clin Gastroenterol 2011; 45: 222-227
26 Hashimoto S, Kobayashi M, Takeuchi M et al. The efficacy of endoscopic triamcinolone injection for the prevention of esophageal stricture after endoscopic submucosal dissection. Gastrointest Endosc 2011; 74: 1389-1393
27 Iizuka H, Kakizaki S, Sohara N et al. Stricture after endoscopic submucosal dissection for early gastric cancers and adenomas. Dig Endosc 2010; 22: 282-288
28 Coda S, Oda I, Gotoda T et al. Risk factors for cardiac and pyloric stenosis after endoscopic submucosal dissection, and efficacy of endoscopic balloon dilation treatment. Endoscopy 2009; 41: 421-426
29 Tsunada S, Ogata S, Mannen K et al. Case series of endoscopic balloon dilation to treat a stricture caused by circumferential resection of the gastric antrum by endoscopic submucosal dissection. Gastrointest Endosc 2008; 67: 979-983
30 Yamaguchi N, Isomoto H, Nakayama T et al. Usefulness of oral prednisolone in the treatment of esophageal stricture after endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. Gastrointest Endosc 2011; 73: 1115-1121
31 Ohara Y, Toyonaga T, Tanaka S et al. Risk of stricture after endoscopic submucosal dissection for large rectal neoplasms. Endoscopy 2016; 48: 62-70
32 Kakushima N, Tanaka M, Sawai H et al. Gastric obstruction after endoscopic submucosal dissection. United European Gastroenterol J 2013; 1: 184-190
33 Kishida Y, Kakushima N, Kawata N et al. Complications of endoscopic dilation for esophageal stenosis after endoscopic submucosal dissection of superficial esophageal cancer. Surg Endosc 2015; 29: 2953-2959
34 Thomas T, Abrams KR, Subramanian V et al. Esophageal stents for benign refractory strictures: a meta-analysis. Endoscopy 2011; 43: 386-393
35 Jeong SH, Lee KJ, Kim YB et al. Diagnostic value of terminal ileum intubation during colonoscopy. J Gastroenterol Hepatol 2008; 23: 51-55