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

Yervant Ichkhanian
 1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
 2  Department of Medicine, Henry Ford Hospital, Detroit, Michigan, USA
,
Mohammed Barawi
 3  Division of Gastroenterology and Hepatology, Ascension St. John Hospital, Detroit, Michigan, USA
,
Talal Seoud
 4  Center for Advanced Endoscopy, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
,
Shyam Thakkar
 4  Center for Advanced Endoscopy, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
,
Truptesh H. Kothari
 5  Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, New York, USA
,
Maan El Halabi
 6  Department of Internal Medicine, Mount Sinai West, New York, New York, USA
,
Asad Ullah
 7  Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum, Offenbach, Germany
,
Wedi Edris
 7  Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum, Offenbach, Germany
,
Patrick Aepli
 8  Department of Gastroenterology and Hepatology, Luzerner Kantonsspital, Luzerne, Switzerland
,
Thomas Kowalski
 9  Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
,
Brianna Shinn
 9  Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
,
10  Division of Gastroenterology and Hepatology, Weill Cornell Medicine/New York, Presbyterian Hospital, New York, New York, USA
,
Srihari Mahadev
10  Division of Gastroenterology and Hepatology, Weill Cornell Medicine/New York, Presbyterian Hospital, New York, New York, USA
,
Jeffrey D. Mosko
11  The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
,
Gianluca Andrisani
12  Digestive Endoscopy Unit, Campus Bio-Medico, University of Rome, Rome, Italy
,
Francesco Maria Di Matteo
12  Digestive Endoscopy Unit, Campus Bio-Medico, University of Rome, Rome, Italy
,
13  Department of Medicine, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
,
Andrew Q. Giap
14  Department of Gastroenterology, Kaiser Permanente, Anaheim, California, USA
,
Shou-jiang Tang
15  Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
,
Yehia M. Naga
15  Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
,
Erwin van Geenen
16  Radboud University Medical Center, Nijmegen, The Netherlands
,
Shai Friedland
17  Division of Gastroenterology, Department of Medicine, Stanford University, Stanford, California, USA
,
Benjamin Tharian
18  Department of Gastroenterology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
,
Shayan Irani
19  Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
,
Andrew S. Ross
19  Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
,
20  Section of Gastroenterology and Hepatology, Beaumont Health-Royal Oak, Royal Oak, Michigan, USA
21  Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
,
Daniel Lew
22  Pancreatic and Biliary Diseases Program, Cedars-Sinai Medical Center, West Hollywood, California, USA
,
Andrew S. Nett
23  Division of Gastroenterology, Sutter Health, Sacramento, California, USA
,
Jad Farha
 1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
,
Thomas M. Runge
 1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
24  Division of Gastroenterology and Hepatology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
,
Manol Jovani
 1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
,
Mouen A. Khashab
 1  Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
› Author Affiliations

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.

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Publication History

Received: 18 July 2020

Accepted: 04 January 2021

Publication Date:
04 January 2021 (online)

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