Endoscopic full-thickness resection of polyps involving the appendiceal orifice: a multicenter international experience

Yervant Ichkhanian; Mohammed Barawi; Talal Seoud; Shyam Thakkar; Truptesh H. Kothari; Maan El Halabi; Asad Ullah; Wedi Edris; Patrick Aepli; Thomas Kowalski; Brianna Shinn; Reem Z. Shariaha; Srihari Mahadev; Jeffrey D. Mosko; Gianluca Andrisani; Francesco Maria Di Matteo; Heinz Albrecht; Andrew Q. Giap; Shou-jiang Tang; Yehia M. Naga; Erwin van Geenen; Shai Friedland; Benjamin Tharian; Shayan Irani; Andrew S. Ross; Laith H. Jamil; Daniel Lew; Andrew S. Nett; Jad Farha; Thomas M. Runge; Manol Jovani; Mouen A. Khashab

doi:10.1055/a-1345-0044

Endoscopy, Table of Contents

Endoscopy 2022; 54(01): 16-24
DOI: 10.1055/a-1345-0044

Original article

Endoscopic full-thickness resection of polyps involving the appendiceal orifice: a multicenter international experience

Authors

Yervant Ichkhanian

¹Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA

²Department of Medicine, Henry Ford Hospital, Detroit, Michigan, USA
Mohammed Barawi

³Division of Gastroenterology and Hepatology, Ascension St. John Hospital, Detroit, Michigan, USA
Talal Seoud

⁴Center for Advanced Endoscopy, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
Shyam Thakkar

⁴Center for Advanced Endoscopy, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
Truptesh H. Kothari

⁵Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, New York, USA
Maan El Halabi

⁶Department of Internal Medicine, Mount Sinai West, New York, New York, USA
Asad Ullah

⁷Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum, Offenbach, Germany
Wedi Edris

⁷Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum, Offenbach, Germany
Patrick Aepli

⁸Department of Gastroenterology and Hepatology, Luzerner Kantonsspital, Luzerne, Switzerland
Thomas Kowalski

⁹Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
Brianna Shinn

⁹Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
Reem Z. Shariaha

¹⁰Division of Gastroenterology and Hepatology, Weill Cornell Medicine/New York, Presbyterian Hospital, New York, New York, USA
Srihari Mahadev

¹⁰Division of Gastroenterology and Hepatology, Weill Cornell Medicine/New York, Presbyterian Hospital, New York, New York, USA
Jeffrey D. Mosko

¹¹The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
Gianluca Andrisani

¹²Digestive Endoscopy Unit, Campus Bio-Medico, University of Rome, Rome, Italy
Francesco Maria Di Matteo

¹²Digestive Endoscopy Unit, Campus Bio-Medico, University of Rome, Rome, Italy
Heinz Albrecht

¹³Department of Medicine, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
Andrew Q. Giap

¹⁴Department of Gastroenterology, Kaiser Permanente, Anaheim, California, USA
Shou-jiang Tang

¹⁵Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
Yehia M. Naga

¹⁵Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
Erwin van Geenen

¹⁶Radboud University Medical Center, Nijmegen, The Netherlands
Shai Friedland

¹⁷Division of Gastroenterology, Department of Medicine, Stanford University, Stanford, California, USA
Benjamin Tharian

¹⁸Department of Gastroenterology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
Shayan Irani

¹⁹Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
Andrew S. Ross

¹⁹Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
Laith H. Jamil

²⁰Section of Gastroenterology and Hepatology, Beaumont Health-Royal Oak, Royal Oak, Michigan, USA

²¹Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
Daniel Lew

²²Pancreatic and Biliary Diseases Program, Cedars-Sinai Medical Center, West Hollywood, California, USA
Andrew S. Nett

²³Division of Gastroenterology, Sutter Health, Sacramento, California, USA
Jad Farha

¹Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
Thomas M. Runge

¹Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA

²⁴Division of Gastroenterology and Hepatology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
Manol Jovani

¹Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
Mouen A. Khashab

¹Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA

Abstract

Background Endoscopic resection of lesions involving the appendiceal orifice remains a challenge. We aimed to report outcomes with the full-thickness resection device (FTRD) for the resection of appendiceal lesions and identify factors associated with the occurrence of appendicitis.

Methods This was a retrospective study at 18 tertiary-care centers (USA 12, Canada 1, Europe 5) between November 2016 and August 2020. Consecutive patients who underwent resection of an appendiceal orifice lesion using the FTRD were included. The primary outcome was the rate of R0 resection in neoplastic lesions, defined as negative lateral and deep margins on post-resection histologic evaluation. Secondary outcomes included the rates of: technical success (en bloc resection), clinical success (technical success without need for further surgical intervention), post-resection appendicitis, and polyp recurrence.

Results 66 patients (32 women; mean age 64) underwent resection of colonic lesions involving the appendiceal orifice (mean [standard deviation] size, 14.5 (6.2) mm), with 40 (61 %) being deep, extending into the appendiceal lumen. Technical success was achieved in 59/66 patients (89 %), of which, 56 were found to be neoplastic lesions on post-resection pathology. Clinical success was achieved in 53/66 (80 %). R0 resection was achieved in 52/56 (93 %). Of the 58 patients in whom EFTR was completed who had no prior history of appendectomy, appendicitis was reported in 10 (17 %), with six (60 %) requiring surgical appendectomy. Follow-up colonoscopy was completed in 41 patients, with evidence of recurrence in five (12 %).

Conclusions The FTRD is a promising non-surgical alternative for resecting appendiceal lesions, but appendicitis occurs in 1/6 cases.

Full Text

References

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