Abstract
Background and study aims Colorectal polyps involving the appendiceal orifice (AO) are difficult to resect
with conventional polypectomy techniques and therefore often require surgical intervention.
These appendiceal polyps could potentially be removed with endoscopic full-thickness
resection (eFTR) performed with a full-thickness resection device (FTRD). The aim
of this prospective observational case study was to evaluate feasibility, technical
success and safety of eFTR procedures involving the AO.
Patients and methods This study was performed between November 2016 and December 2017 in a tertiary referral
center by two experienced endoscopists. All patients referred for eFTR with a polyp
involving the AO that could not be resected by EMR due to more than 50 % circumferential
involvement of the AO or deep extension into the AO were included. The only exclusion
criterion was lesion diameter > 20 mm.
Results Seven patients underwent eFTR for a polyp involving the AO. All target lesions could
be reached with the FTRD and retracted into the device. Technical success with an
endoscopic radical en-bloc and full-thickness resection was achieved in all cases.
Histopathological R0 resection was achieved in 85.7 % of patients (6/7). One patient
who previously underwent an appendectomy developed a small abscess adjacent to the
resection site, which was treated conservatively. Another patient developed secondary
appendicitis followed by a laparoscopic appendectomy.
Conclusion This small exploratory study suggests that eFTR of appendiceal polyps is feasible
and can offer a minimally invasive approach for radical resection of these lesions.
However, more safety and long-term follow-up data are needed to evaluate this evolving
technique.
