Efficacy of endoscopic submucosal dissection for superficial neoplastic lesions in the ileocecal valve region: a large multi-center comparative study.

BACKGROUND AND AIMS: Endoscopic submucosal dissection (ESD) of ileocecal valve (ICV) polyps potentially offers higher en bloc resection and lower recurrent rates than endoscopic mucosal resection. However, evidence regarding safety and efficacy of ICV polyp ESD compared to non-ICV polyps remain limited. We aim to assess the safety and efficacy of ICV polyps ESD versus polyps in the right colon.

METHODS: A multi-center, retrospective cohort study was conducted at 11 referral centers. Polyps in the proximal right-sided colon treated by ESD were included and categorized into ICV and non-ICV group. The primary outcomes were en bloc, R0, curative resection rate. The secondary outcomes were procedural time, adverse event, and local recurrence rates.

RESULTS: A total of 414 patients (age 65.6 ± 11.3 years, 51.7% male) were enrolled (76 ICV and 338 non-ICV). The overall mean polyp size was 37 ± 19 mm. The mean ICV circumferential involvement was 35 ± 23%, with 3(3.9%) lesions with ileal extension. Complete resection rate was comparable between groups (100% vs 99.7%; p = 0.86). ICV group showed lower en bloc (82% vs 93%, p = 0.004), R0 (74% vs 86%, p = 0.001), curative resection rate (74% vs 86%, p = 0.021), and higher post-procedural bleeding rate (9.2% vs 2.7%; p = 0.003). Local recurrence rates were similar (8% vs 6%; p = 0.75), with 90% of recurrences treated endoscopically.

CONCLUSION: ESD of ICV polyps in expert hands is safe with high rate of complete resection. Despite a lower en bloc resection and higher post-ESD bleeding rate compared to non-ICV polyps, ESD remains an alternative option for large ICV polyps.