Superficial tumors involving terminal ileum treated by endoscopic submucosal dissection.

Abstract

It is recognized that superficial tumors of the ileocecal transition pose a higher degree of complexity for endoscopic resection and surgical treatment is sometimes required in cases of incomplete resection. We report some rare cases of superficial tumors involving the terminal ileum treated by endoscopic submucosal dissection (ESD). A 58-year-old woman was referred to our hospital for treatment of a superficial tumor involving the terminal ileum. Endoscopy showed a slightly elevated (type 0-IIa) tumor located at the ileocecal transition. The tumor could be resected en bloc by ESD with a combination of a small-caliber-tip transparent hood and a flex knife without any complications. A 61-year-old man was also referred to our hospital for treatment of a slightly elevated (type 0-IIa) tumor located at the ileocecal transition. The tumor could be resected en bloc. Both resected specimens showed intramucosal adenocarcinomas with clear lateral and vertical margins. By applying ESD with a combination of a flex knife and a small-caliber-tip transparent hood, the superficial tumors involving the terminal ileum were resected en bloc without any complications and the ileocecal valve was preserved in both cases.