Hybrid endoscopic submucosal dissection-endoscopic mucosal resection of large polyps at the ileocecal valve.

Background and Aims: Endoscopic resection of polyps at the ileocecal valve (ICV) remains challenging. Herein, we present a review of the current literature and a case series with video of hybrid endoscopic submucosal dissection-endoscopic mucosal resection (ESD-EMR) for the management of polyps at the ICV. Methods: This article and accompanying video outline the technique of hybrid ESD-EMR. This technique was ultimately used for the management of ICV polyps in 10 patients at a single-center institution. Results: As outlined in the video, endoscopic submucosal dissection was first performed to create a "trench" for the snare to anchor into the lesion and ensure negative margins at the ileal aspect of the lesion. Endoscopic mucosal resection was then performed in a piecemeal or en bloc fashion to complete resection of the polyp. Technical success of the procedure was 100%. Adverse events were noted in 20% of cases, consisting of 1 case of postpolypectomy syndrome (American Society for Gastrointestinal Endoscopy [ASGE] grade I) and 1 case of early bleeding (ASGE grade IIIa). One patient had residual disease on follow-up that was easily managed endoscopically. No patients required surgical referral after endoscopic resection. Conclusion: We conclude that hybrid ESD-EMR may be an effective resection strategy for the management of large polyps at the ICV.