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01-03-2020 | Endoscopy | The Last Image
Cap-assisted aspiration mucosectomy of a laterally spreading ileocecal valve lesion
Published in: Techniques in Coloproctology | Issue 3/2020
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There are various degrees of difficulty in endoscopic resection of complex laterally spreading lesions (LSLs) involving the ileocecal valve (ICV) mostly depending on ileal invasion depth and degree of circumferential involvement [1]. Cap-assisted endoscopy has been reported to have high rates of technical and clinical success [2] (Fig. 1). However, while such a short-hood cap approach might be instrumental in scope and visual field stabilization, cap-assisted aspiration mucosectomy has been studied to only a minor extent [3].
Fig. 1
Cap-assisted aspiration mucosectomy of an ICV lesion of a 71-year-old male patient referred after office-based colorectal cancer screening: a–c An estimated 35-mm laterally spreading lesion (LSL granular type (LSL-G; Paris Is + IIa) with > semicircumferential ICV involvement over its superior lip and limited extension < 5 mm into the terminal ileum. Note sparing of the inferior IVC lip. d Extensive washing and ancillary acetic acid spraying highlighted the surface pattern without evidence for advanced neoplasia (as confirmed by final pathology indicative of low-grade adenoma). e, f After switching to cap-fitted endoscopy using a long resection cap, endoscopic aspiration mucosectomy was performed in a piecemeal fashion with judicious suctioning, avoiding complete filling of the cap. Note the ample amounts of submucosal fat tissue as is typical in this anatomic localization. g Final assessment of the resection bed indicating > semicircumferential resection without remaining LSL tissue towards the oral margin. h, i Endoscopy ay 6 months after resection shows minor semicircumferential stricture formation due to extensive scarring in the absence of macroscopic (and microscopic) recurrence/persistence
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