case_images: PMC11058687_01
case_images: (a) A colonoscopy revealed a 30 mm subepithelial lesion in the cecum. (b) The base of the lesion originated from the ileum, and a diagnosis of terminal ileal lipoma was made. (c) After further pulling out the lesion into the cecum, injection of hyaluronic acid at the base of the lesion stabilized its position. (d) The lesion was resected en bloc by endoscopic mucosal resection. (e) Hemostatic clips were applied on visible vessels. (f) After resection en bloc, a capsulated yellowish lesion was seen under the epithelium.
case_images: DEO2-5-e375-g003.jpg
case_images: PMC11058687_01_DEO2-5-e375-g003.jpg
case_images: deo2375-fig-0002
case_images: A 74-year-old male with Diabetes Mellitus had a colonoscopy performed for a routine checkup, revealing a yellowish 30mm subepithelial lesion protruding out of the ileocecal valve (Figure 2a). The lesion was soft, with a positive cushion sign, and the surface was covered with normal mucosa (Figure 2b). The lesion was further pulled out into the cecum using a snare until the base of the lesion could be observed circumferentially, and the swelling produced by the injection of hyaluronic acid at the base of the lesion secured its position (Figure 2c). Thereafter, the lesion was resected en bloc by EMR using Snaremaster (Olympus) without adverse events (Figure 2d). Visible vessels were closed using hemostatic clips for prophylaxis of delayed bleeding (Figure 2e). The specimen was 30 x 30 x 18 mm, and the histological result showed lipoma (Figure 2f).
case_images: PMC11058687_02
case_images: (a) Initially, a 30 mm, reddish, subepithelial lesion was observed, protruding out of the ileocecal valve. (b) Upon insufflation, the lesion was pulled into the ileum, fully occupying the lumen. (c) The lesion was extracted into the cecum and secured in position using clip and band traction between the cecal wall and the base of the lesion. (d) During dissection, the clip and band traction continuously acted as counter traction, enabling visualization of the plane of dissection. A yellowish subepithelial lesion began to appear under the epithelium. An additional elastic traction device was attached to the ileal side of the dissection plane. (e) The post-endoscopic submucosal dissection defect was fully closed within the cecum using clips, and the traction band was detached for the defect to return inside the ileum. (f) A capsulated yellowish lesion was resected en bloc.
case_images: DEO2-5-e375-g002.jpg
case_images: PMC11058687_02_DEO2-5-e375-g002.jpg
case_images: deo2375-fig-0003
case_images: A 53-year-old male underwent a routine colonoscopy which revealed a 35 mm, subepithelial lesion at the terminal ileum, protruding from the ileocecal valve (Figure 3a). Within the ileum, the lesion fully occupied the narrow lumen, making observation of the oral side difficult (Figure 3b). The same procedure was repeated on the other side of the base for stabilization (Figure 3c). The clip and band acted as continuous traction, further pulling the lesion into the cecum allowing a better view of the dissection plane (Figure 3d). A soft, yellowish lesion was observed as dissection proceeded (Figure 3d), and the whole lesion was resected en bloc, within 30 minutes, without any adverse events.  Before the lesion was completely resected, additional traction was applied with an elastic traction device between the cecal wall and the normal ileal mucosa on the oral side, such that the post-ESD defect would remain in the cecum and not get pulled into the ileum after resection of the lesion (Figure 3d). This allowed clear visualization and hence, a secure and complete closure of the defect (Figure 3e). The resected specimen was 34 x 33 x 14 mm, and the histological result showed lipoma without any evidence of adenoma (Figure 3f; Video S1).