Endoscopy 2020; 52(01): E7-E8
DOI: 10.1055/a-0977-2516
E-Videos
© Georg Thieme Verlag KG Stuttgart · New York

Circumferential ileocecal valve removal for a colonic polyp using underwater endoscopic mucosal resection

Mitsuhiro Kono
Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Yoji Takeuchi
Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Koji Higashino
Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Noriya Uedo
Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Ryu Ishihara
Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
› Author Affiliations
Further Information

Corresponding author

Yoji Takeuchi, MD
Department of Gastrointestinal Oncology
Osaka International Cancer Institute
3-1-69 Otemae, Chuo-ku
Osaka, 541-8567
Japan   
Fax: +81-6-69451902   

Publication History

Publication Date:
09 August 2019 (online)

 

    A 65-year-old man with constipation and a positive fecal occult blood test had previously undergone a colonoscopy in another hospital, which had revealed a polyp measuring 40 mm in diameter at the cecum. He was referred to our hospital for treatment of the lesion, with colonoscopy revealing a polypoid lesion on the upper lip of the ileocecal valve ([Fig. 1 a]). Because no definitive endoscopic findings suggestive of deep submucosal invasion were revealed by magnifying narrow-band imaging and chromoendoscopy, underwater endoscopic mucosal resection (UEMR) was performed using an electrosurgical snare (33-mm wide; Captivator II; Boston Scientific, Natick, Massachusetts, USA). As it was impossible to observe the distal side of the lesion when it was snared, we snared the whole ileocecal valve. Forced coagulation mode was used briefly twice and the lesion was then removed using Endocut Q mode. The lesion was completely resected along with the ileocecal valve ([Fig. 1 b]; [Video 1]). We did not perform any additional procedures, such as steroid injection, which has been reported to be effective in preventing stricture after semicircumferential removal of esophageal lesions, because there is no clear evidence regarding such use for ileocecal lesions.

    Zoom Image
    Fig. 1 Endoscopic images showing: a a polypoid lesion, which measured 40 mm in diameter, on the ileocecal valve; b the resection site following complete resection of the lesion along with the ileocecal valve by underwater endoscopic mucosal resection.

    Video 1 A polypoid lesion was completely resected along with the ileocecal valve by underwater endoscopic mucosal resection.


    Quality:

    Histological examination of the resected lesion showed an intramucosal well-differentiated tubular adenocarcinoma in an adenoma ([Fig. 2]).

    Zoom Image
    Fig. 2 Macroscopic appearance of the resected specimen, which was shown to be an intramucosal well-differentiated tubular adenocarcinoma in an adenoma, with no submucosal invasion.

    At colonoscopy 6 months after the UEMR, the ileocecal valve was scarred without local residue or stenosis ([Fig. 3]). The patient’s constipation had improved.

    Zoom Image
    Fig. 3 Endoscopic image 6 months after the underwater endoscopic mucosal resection showing a scarred ileocecal valve with no local residue or stenosis.

    Endoscopy_UCTN_Code_TTT_1AQ_2AD

    Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high
    quality video and all contributions are
    freely accessible online.

    This section has its own submission
    website at
    https://mc.manuscriptcentral.com/e-videos


    #

    Competing interests

    None

    Acknowledgments

    We thank Hugh McGonigle from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.


    Corresponding author

    Yoji Takeuchi, MD
    Department of Gastrointestinal Oncology
    Osaka International Cancer Institute
    3-1-69 Otemae, Chuo-ku
    Osaka, 541-8567
    Japan   
    Fax: +81-6-69451902   


    Zoom Image
    Fig. 1 Endoscopic images showing: a a polypoid lesion, which measured 40 mm in diameter, on the ileocecal valve; b the resection site following complete resection of the lesion along with the ileocecal valve by underwater endoscopic mucosal resection.
    Zoom Image
    Fig. 2 Macroscopic appearance of the resected specimen, which was shown to be an intramucosal well-differentiated tubular adenocarcinoma in an adenoma, with no submucosal invasion.
    Zoom Image
    Fig. 3 Endoscopic image 6 months after the underwater endoscopic mucosal resection showing a scarred ileocecal valve with no local residue or stenosis.