title: Cap-assisted endoscopic mucosal resection of large polyps involving the ileocecal valve.
abstract: Standard endoscopic mucosal resection (EMR) is limited with regard to lesions below or involving the ileocecal valve. We describe the treatment and outcomes when using cap-assisted EMR (EMR-C) to remove large laterally spreading tumors (LSTs) with ileal infiltration in seven patients (median age 74 years). Each LST (median size 40 mm) was successfully resected in one session (median procedure time 50 minutes). Intraprocedural and early bleeding occurred in two patients, and delayed hemorrhage in one. Circumferential resection of the ileum caused asymptomatic strictures in six patients, with regression during follow-up for five. We conclude that the novel EMR-C method is a potentially effective treatment for cecal LST involving the distal ileum. Serious complications such as perforation or symptomatic strictures of the ileocecal valve were not observed and any procedure-related bleeding was easily controlled.
authors.affiliation: Department of Gastroenterology, General Hospital, Sanremo, Italy. mxconio@tin.it
authors.forename: M
authors.initials: M
authors.lastname: Conio
authors.forename: S
authors.initials: S
authors.lastname: Blanchi
authors.forename: R
authors.initials: R
authors.lastname: Filiberti
authors.forename: C
authors.initials: C
authors.lastname: Ruggeri
authors.forename: D A
authors.initials: DA
authors.lastname: Fisher
mesh_terms: D018253:Adenoma, Villous / Q000473:pathology / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D002430:Cecal Neoplasms / Q000473:pathology* / Q000601:surgery*; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007078:Ileal Neoplasms / Q000473:pathology* / Q000601:surgery*; D007080:Ileocecal Valve / Q000473:pathology* / Q000601:surgery*; D007082:Ileum / Q000473:pathology / Q000601:surgery; D007413:Intestinal Mucosa / Q000473:pathology* / Q000601:surgery*; D007417:Intestinal Polyps / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies