CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(03): E388-E395
DOI: 10.1055/a-1072-4830
Original article
Owner and Copyright © Georg Thieme Verlag KG 2020

ESD with double clips and rubber band traction of neoplastic lesions developed in the appendiceal orifice is effective and safe

Borathchakra Oung
1  Department of Endoscopy and Gastroenterology, Pavillon L, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
2  Cambodian Association of Gastrointestinal Endoscopy (CAGE), Cambodia
,
Jérôme Rivory
1  Department of Endoscopy and Gastroenterology, Pavillon L, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
Edouard Chabrun
3  Department of Endoscopy and Gastroenterology, Bordeaux University Hospital, Bordeaux, France
,
Romain Legros
4  Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
,
Julien Faller
1  Department of Endoscopy and Gastroenterology, Pavillon L, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
Florence Léger-Nguyen
5  Gastroenterology and Endoscopy, Val d’ouest private clinic, Ecully, France
,
Florian Rostain
1  Department of Endoscopy and Gastroenterology, Pavillon L, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
Charles-Eric Ber
6  Department of Anesthesiology, Pavillon L, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
Valérie Hervieu
7  Department of Pathology, Pavillon L, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
Jean-Christophe Saurin
1  Department of Endoscopy and Gastroenterology, Pavillon L, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
Thierry Ponchon
1  Department of Endoscopy and Gastroenterology, Pavillon L, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
Jérémie Jacques
4  Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
,
Mathieu Pioche
1  Department of Endoscopy and Gastroenterology, Pavillon L, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
› Author Affiliations
Further Information

Publication History

submitted 01 July 2019

accepted after revision 17 November 2019

Publication Date:
21 February 2020 (online)

Abstract

Background and study aims Endoscopic submucosal dissection (ESD) of superficial colorectal lesions in close proximity to the appendiceal orifice (L-PAO) was shown to be feasible except in case of deep invasion into the appendix (type 3 of Toyonaga’s classification). This study aimed to determine the outcomes of ESD with double clip and rubber band traction (DCT-ESD) of L-PAO including a majority of type 3.

Patients and methods We reviewed retrospectively all consecutive DCT-ESD of L-PAO performed in 3 French centers. Each lesion was described according to Toyonaga’s classification and type 0 lesions were excluded. The primary outcome was en bloc and R0 resection rates for L-PAO. Morbidity and salvage surgery were recorded.

Results A total of 32 patients underwent DCT-ESD; 22 lesions (68.8 %) were type 3, including 11 with previous appendectomy (34.4 %). Median lesion size was 35 mm range (10–110 mm) and median duration of resection was 47 min range (10–230 min). We achieved 100 % of En bloc resection exclusively with DCT-ESD and 90.6 % of histological R0 resection rate. Per-procedure, 11 perforations occurred and were all immediately closed with clips. Overall, 3 patients (10.7 %) underwent surgery without stoma (2 complications related and 1 incomplete resection). No death occurred.

Conclusion ESD of lesions deeply invading appendiceal orifice is feasible with the help of a traction system. Technical success by endoscopy avoiding surgery was achieved in 90.6 % of cases.