CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(12): E1646-E1651
DOI: 10.1055/a-0990-9035
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

Endoscopic management of large ileocecal valve lesions over an 18-year interval

Prasanna L. Ponugoti
Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University School of Medicine
,
Heather M. Broadley
Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University School of Medicine
,
Jonathan Garcia
Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University School of Medicine
,
Douglas K. Rex
Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University School of Medicine
› Author Affiliations
Further Information

Publication History

submitted: 21 November 2018

accepted after revision: 17 April 2019

Publication Date:
25 November 2019 (online)

Abstract

Background and study aims Ileocecal valve (ICV) lesions are challenging to remove endoscopically.

Patients and methods This was a retrospective cohort study, performed at an academic tertiary US hospital. Sessile polyps or flat ICV lesions ≥ 20 mm in size referred for endoscopic mucosal resection (EMR) were included. Successful resection rates, complication rates and recurrence were compared to lesions ≥ 20 mm in size not located on the ICV.

Results During an 18-year interval, there were 118 ICV lesions ≥ 20 mm with mean size 28.6 mm (44.9 % females; mean age 71.6 years), comprising 9.03 % of all referred polyps. Ninety ICV lesions (76.3 %) were resected endoscopically, compared to 91.3 % of non-ICV lesions (P < 0.001). However, in the most recent 8 years, successful EMR of ICV lesions increased to 93 %. Conventional adenomas comprised 92.2 % of ICV lesions and 7.8 % were serrated. Delayed hemorrhage and perforation occurred in 3.3 % and 0 % of ICV lesions, respectively, compared to 4.8 % and 0.5 % in the non-ICV group. At first follow-up, rates of residual polyp in the ICV and non-ICV groups were 16.5 % and 13.6 %, respectively (P = 0.485). At second follow-up residual rates in the ICV and non-ICV lesion groups were 18.6 % and 6.7 %, respectively (P = .005).

Conclusions Large ICV polyps are a common source of tertiary referrals. Over an 18-year experience, risk of EMR for ICV polyps was numerically lower, and risk of recurrence was numerically higher at first follow and significantly higher at second follow-up compared to non-ICV polyps.

 
  • References

  • 1 Tutticci N, Klein A, Sonson R. et al. Endoscopic resection of subtotal or completely circumferential laterally spreading colonic adenomas: technique, caveats, and outcomes. Endoscopy 2016; 48: 465-471
  • 2 Hassan C, Senore C, Radaelli F. et al. Full-spectrum (FUSE) versus standard forward-viewing colonoscopy in an organised colorectal cancer screening programme. Gut 2017; 66: 1949-1955
  • 3 Ahlenstiel G, Hourigan LF, Brown G. et al. Actual endoscopic versus predicted surgical mortality for treatment of advanced mucosal neoplasia of the colon. Gastrointest Endosc 2014; 80: 668-676
  • 4 Raju GS, Lum PJ, Ross WA. et al. Outcome of EMR as an alternative to surgery in patients with complex colon polyps. Gastrointest Endosc 2016; 84: 315-325
  • 5 Lee EY, Bourke MJ. EMR should be the first-line treatment for large laterally spreading colorectal lesions. Gastrointest Endosc 2016; 84: 326-328
  • 6 Sanchez-Yague A, Kaltenbach T, Raju G. et al. Advanced endoscopic resection of colorectal lesions. Gastroenterol Clin North Am 2013; 42: 459-477
  • 7 Rutter MD, Nickerson C, Rees CJ. et al. Risk factors for adverse events related to polypectomy in the English Bowel Cancer Screening Programme. Endoscopy 2014; 46: 90-97
  • 8 Tate DJ, Desomer L, Klein A. et al. Adenoma recurrence after piecemeal colonic EMR is predictable: the Sydney EMR recurrence tool. Gastrointest Endosc 2017; 85: 647-656.e646
  • 9 Aziz Aadam A, Wani S, Kahi C. et al. Physician assessment and management of complex colon polyps: a multicenter video-based survey study. Am J Gastroenterol 2014; 109: 1312-1324
  • 10 Hassan C, Quintero E, Dumonceau JM. et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2013; 45: 842-851
  • 11 Lieberman DA, Rex DK, Winawer SJ. et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012; 143: 844-857
  • 12 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
  • 13 Moss A, Williams SJ, Hourigan LF. et al. Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut 2015; 64: 57-65
  • 14 Parsa N, Rex DK. Short cap technique to complete EMR of very flat colorectal laterally spreading tumors. VideoGIE 2017; 2: 229-230
  • 15 Andrawes S, Haber G. Avulsion: a novel technique to achieve complete resection of difficult colon polyps. Gastrointest Endosc 2014; 80: 167-168
  • 16 Khashab M, Eid E, Rusche M. et al. Incidence and predictors of “late” recurrences after endoscopic piecemeal resection of large sessile adenomas. Gastrointest Endosc 2009; 70: 344-349
  • 17 Jayanna M, Burgess NG, Singh R. et al. Cost analysis of endoscopic mucosal resection vs surgery for large laterally spreading colorectal lesions. Clin Gastroenterol Hepatol 2016; 14: 271-278 e271-272
  • 18 Keswani RN, Law R, Ciolino JD. et al. Adverse events after surgery for benign colon polyps are common and associated with increased length of stay and costs. Gastrointest Endosc 2016; 84: 296-303.e1
  • 19 Peery AF, Shaheen NJ, Cools KS. et al. Morbidity and mortality after surgery for nonmalignant colorectal polyps. Gastrointest Endosc 2018; 87: 243-250.e242
  • 20 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