RELEVANCE

There are clinical and national recommendations for the removal of neoplasms in the upper and lower parts of the digestive tract. At the same time, most removal methods describe neoplasms located in a specific part of the small intestine (SI), the duodenum. There is no information in the publications concerning which method should be used to remove tumors in the terminal ileum. Our goal being to draw the attention of colleagues to the need of thorough examination of the terminal ileum and to diagnose possible pathologies while performing a colonoscopy.

OBJECTIVE

We present the first successful cases of performing the mucosa cold snare resection method — «polypectomy» — in the terminal ileum.

MATERIAL AND METHODS

Of the 12.340 colonoscopies (with a mandatory assessment of the terminal ileum) performed by us, 6.540 (53%) colonoscopies revealed epithelial neoplasms in the large intestine, including those in the terminal section of small intestine in 2 (0.016%) patients. In addition, other pathologies were revealed in the terminal part of the SI: signs of ileitis, erosions, neuroendocrine tumors. An endoscopic removal of the epithelial neoplasm by CSP (cold snare polypectomy) was performed directly.

RESULTS

In two cases, it was possible to remove epithelial neoplasms «en bloc». The bleeding from the wound stopped spontaneously. On follow-up examination, there was no ongoing bleeding. Histological examination confirmed results of tubular adenomas of the ileum in both cases. There were no complications in the postoperative period. No recurrence has been identified.

CONCLUSIONS

We have demonstrated the results of applying the method of cold resection in the terminal ileum, showing the possibility of removing benign epithelial neoplasms «en bloc». This method of removal is considered effective as a radical treatment, at the same time high-quality histological verification of the diagnosis is possible.