Traction-assisted endoscopic submucosal dissection to resect ileo-cecal valve neoplasia: a French retrospective multicenter case series.

The ileocecal valve (ICV) is considered to be one of the most difficult locations for endoscopic submucosal dissection (ESD). The objective of this study was to evaluate the efficacy and safety of traction-assisted ESD in this situation. All patients who underwent traction assisted ESD for an ICV lesion were identified from a prospective ESD database in three centers. The results were evaluated in terms of en bloc, R0 rate. Factors associated with R0 failure were explored. In total, 106 patients with an ileocecal lesion were included. The median diameter of the lesions was 50 mm (IQR 38-60) and 58.4% (62/106) invaded the terminal ileum. The en-bloc and R0 resection rates were 94.8% and 76.4%, respectively. Factors associated with R0 failure were lesions covering more than 75% of the ICV (OR, 0.21 [0.06, 0.76] p = 0.018), anal lip involvement (OR 0.36 [0.13, 0.99], p= 0.037), and more than two sites of the ICV (OR 0.28 [0.08, 1.01] p = 0.030). Traction-assisted ESD to treat ICV lesions is a safe and feasible option. Large lesions and anal lip involvement appear to be factors predictive of difficulty.

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CY : consultant and lectures for Abbvie, Takeda, Jansen, Amgen, Galapagos JR : Honorary for Training sessions in endoscopy and endoscopic resection for Olympus, Cook Medical, MS : Honorary for training session for Boston Scienfics. Invitation for congress by olympus, cook, cousin medical, boston, pentax, abbvie, MSD, amgen, norgine MP: Honorary for Training sessions in endoscopy and endoscopic resection for Olympus, Cook Medical, Boston scientific, Pentax Medical. Honorary for Training sessions in endoscopic characterization with Norgine, Provepharm. Uegw invitation by AlfaSigma. Patent of our institution Hospices civils de Lyon for IPEFIX device JJ : ESD training sessions: Olympus, Fuji, Erbe, Pentax, lumendi Lectures: Abbvie, Janssen, norgine TW: Honorary for ESD training sessions: Olympus, Fujifilm. Lectures for Mayoli. The other authors have no COI