Saline-immersion technique for endoscopic submucosal dissection with traction for an ileocecal adenoma involving the ileal outlet.

Background and Aims: Endoscopic submucosal dissection (ESD) of lesions involving the ileocecal valve and terminal ileum is technically challenging. The saline-immersion technique for ESD combined with countertraction may improve visualization, safety, and dissection efficiency in these complex locations. Methods: A 71-year-old patient underwent ESD for a 4-cm nongranular flat adenoma involving the entire ileocecal valve and extending into the distal terminal ileum. The procedure was performed with the patient under general anesthesia using a pediatric colonoscope (PCF-H190TL; Olympus, Tokyo, Japan) with a tapered hood (ST Hood; Fujifilm, Tokyo, Japan). After chromoendoscopic margin delineation, the lumen was filled with saline solution, and submucosal dissection was completed under saline immersion using ENDO CUT current (Erbe VIO 3, Tübingen, Germany). Two clip-and-band complexes provided internal countertraction to improve exposure and facilitate controlled dissection. Results: En bloc resection, including the ileocecal valve and ileal extension, was achieved. Hemostasis was secured with hot biopsy forceps, and partial defect closure was performed with clips. The postoperative course was uneventful, and the patient was discharged after 48 hours. Oral budesonide was administered for 2 months to reduce the risk of stricture. At 3-month follow-up, the patient was asymptomatic without endoscopic recurrence. Conclusions: Under-saline solution ESD with clip-and-band traction appears safe and effective for extensive ileocecal lesions, providing stable visualization, reliable countertraction, and easy access to the submucosal space.