title: Endoscopic mucosal resection of laterally spreading lesions involving the ileocecal valve: technique, risk factors for failure, and outcomes.
abstract: OBJECTIVE
  Endoscopic mucosal resection (EMR) of laterally spreading lesions (LSLs) involving the ileocecal valve (ICV) is technically demanding. Conventionally, these lesions are considered too challenging for endoscopic therapy and are primarily managed surgically. The aims of the study were to describe effectiveness, safety, and outcomes following EMR of LSLs at the ICV.
  
  
  METHODS
  This was a single-center, prospective, observational, cohort study performed at an academic, tertiary referral center. Patients undergoing EMR for LSLs ≥ 20 mm involving the ICV were recruited over a 5-year period. Standard or cap-assisted colonoscopy with inject-and-resect EMR technique was performed with standardized post-EMR management. Procedural success, safety, and outcomes compared with non-ICV LSLs managed during the same period were analyzed.
  
  
  RESULTS
  A total of 53 patients with ICV LSLs were referred for EMR (median age 69 years; median lesion size 35.0 mm; 52.8 % females). Six patients went directly to surgery because of an endoscopic diagnosis of malignancy (n = 2) or technical failure of EMR (n = 4). EMR achieved complete adenoma clearance in 44 out of 47 attempted (93.6 %). Surgery was ultimately avoided in 43/53 (81.1 %). Complications included bleeding in 6.4 %. There were no perforations or strictures. Early adenoma recurrence was detected in 7/40 patients (17.5 %), and 1/22 (4.5 %) had late recurrence. All were successfully managed endoscopically. Factors associated with failure of ICV EMR were ileal infiltration and involvement of both ICV lips.
  
  
  CONCLUSIONS
  In the majority of cases, LSL involving the ICV can be effectively treated by EMR on an outpatient basis. In specialized centers, complications are infrequent, and  > 80 % of patients ultimately avoid surgery. Trial registered at ClinicalTrials.gov (NCT01368289).
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.
authors.forename: Kavinderjit S
authors.initials: KS
authors.lastname: Nanda
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Tutticci
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Burgess
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Sonson
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Williams
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bourke
mesh_terms: D000368:Aged; D003113:Colonoscopy / Q000379:methods*; D004210:Dissection / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007078:Ileal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D007080:Ileocecal Valve; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery*; D008297:Male; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D011446:Prospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D016896:Treatment Outcome