Endoscopy 2019; 51(04): S12-S13
DOI: 10.1055/s-0039-1681205
ESGE Days 2019 oral presentations
Friday, April 5, 2019 08:30 – 10:30: Colon ESD South Hall 2B
Georg Thieme Verlag KG Stuttgart · New York

ESD WITH DOUBLE CLIP AND RUBBER BAND TRACTION OF NEOPLASTIC LESIONS DEVELOPED IN THE APPENDICEAL ORIFICE IS EFFECTIVE AND SAFE

B Oung
1   Gastroenterology and Endoscopy Unit, Pavillon H, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
J Jacques
2   Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
,
J Rivory
1   Gastroenterology and Endoscopy Unit, Pavillon H, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
R Legros
2   Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
,
F Rostain
1   Gastroenterology and Endoscopy Unit, Pavillon H, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
E Chabrun
3   Gastroenterology and Endoscopy Unit, Haut l'Eveque University Hospital, Bordeaux, France
,
V Hervieu
4   Anatomy and Pathology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
M Moreno-Garcia
1   Gastroenterology and Endoscopy Unit, Pavillon H, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
JC Saurin
1   Gastroenterology and Endoscopy Unit, Pavillon H, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
T Ponchon
1   Gastroenterology and Endoscopy Unit, Pavillon H, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
M Pioche
1   Gastroenterology and Endoscopy Unit, Pavillon H, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
5   Inserm U 1032, Labtau, Lyon, France
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 
 

    Aims:

    Endoscopic resection of Superficial Colorectal lesions in close proximity to the Appendiceal Orifice (L-PAO) was shown to be feasible but is considered impossible in case of deep invasion into the appendix (type 3). We report here a series of Endoscopic Submucosal Dissection with double clip and rubber band traction (DCT-ESD) of L-PAO to determine the outcomes.

    Methods:

    We reviewed retrospectively 21 resections of L-PAO in 3 centers. Toyonaga classification was described for each lesion. We excluded type 0 lesions which are not in contact of appendiceal orifice. Our primary outcome was En bloc resection rate and R0 resection rate. The morbidities (bleeding, perforation and acute appendicitis) and alternative surgery were studied as well.

    Results:

    21 patients underwent DCT-ESD (mean of age 69-year-old). 6 patients had previous appendectomy (28.6%). The dominant localization type of lesion was type 3 (enter deeply in appendiceal orifice) with 14 lesions (66.7%), followed by 6 type 2 lesions (enters orifice, and transition to normal appendiceal mucosa is discernible on inspection of the appendiceal lumen) (28.6%) and 1 type 1 lesion (reaches border of the appendix, but does not enter orifice) (4.8%). The mean lesion size was 38 mm (10 – 70 mm) and the mean duration of resection was 63 min (10 – 230 min). En bloc resection was achieved in all cases, while 1 resection was not R0 and was found to have lateral contact with low grade dysplasia (2 pathologies is still ongoing). 8 perforations occurred during procedure and were immediately closed by clips. Among them, one patient (4.8%) experienced postoperative perforation associated with acute appendicitis and was successfully resolved by an alternative surgery. There was no death, nor any stomia reported in our series.

    Conclusions:

    DCT-ESD is effective and safe for lesions developed in appendiceal orifice. A surprisingly large amount of curative resection was accomplished with just endoscopic procedure alone.


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