Endoscopic submucosal dissection for large laterally spreading tumors involving the ileocecal valve and terminal ileum

Figure 1 Pre-treatment endoscopic evaluation. A: Close view of the cecum revealed a 70 mmIs +IIa, LST granular type (LST-G) lesion; B: Clearly delineated margin of the LST-G lesion after 0.4% indigo-carmine dye spraying; C: Magnification view of the Is component of the Is +IIa (LST-G); D: Spreading confirmation of the tumor through the ileocecal valve to the terminal ileum.

Figure 2 Procedure. A: Endoscopic view through the distal attachment showing dissection with insulation-tip knife; B: Carefully check for bleeding throughout the ileocecal region; C: The ulcer bed of ileum after en-bloc endoscopic submucosal dissection; D: Stereomicroscopic view presenting the resected specimen, which pathology reported as a Is+IIa intramucosal cancer with tumor-free margins of 70 mm in diameter.

Figure 3 Post-endoscopic submucosal dissection follow-up endoscopic view of the cecum. A: After 6 mo, it shows mildly deformed ileocecal valve due to post-operative scar; B: Following indigo-carmine spraying, no recurrence can be seen.