Loop-tipped guidewire-assisted cannulation of disposable imaging catheter into appendiceal lumen for difficult endoscopic retrograde appendicitis therapy

Endoscopic retrograde appendicitis therapy (ERAT) is an emerging minimally invasive approach for the diagnosis and treatment of acute appendicitis [1]. The disposable imaging catheter provides direct visualization of the appendiceal lumen, enabling irrigation, fecalith removal, and stent placement [2]. Similarly to endoscopic retrograde cholangiopancreatography (ERCP), cannulation in ERAT remains challenging due to edematous or stenotic appendiceal orifices [3]. This report describes a novel technique using a loop-tipped guidewire to guide a disposable imaging catheter to the appendiceal orifice during difficult intubation, facilitating successful cannulation.

A 24-year-old man with a 5-day history of right lower quadrant pain declined surgery in favor of conservative management. Computed tomography showed appendiceal dilation (14 mm) with peri-appendiceal inflammation ([Fig. 1] a). ERAT was proposed as an alternative therapeutic approach.

Fig. 1 Loop-tipped guidewire-assisted cannulation of disposable imaging catheter into the appendiceal lumen. a Computed tomography showing dilated appendix (14 mm). b Loop-tipped guidewire modification. c Edematous appendiceal orifice on colonoscopy. d Successful catheter cannulation. e Endoscopic view of purulent debris. f Deployed single-pigtail stent.

A standard ERCP guidewire (Jagwire; Boston Scientific, Marlborough, Massachusetts, USA) was manually shaped to form a loop at its tip ([Fig. 1] b). Colonoscopy identified a severely edematous and hyperemic appendiceal orifice ([Fig. 1] c). The disposable imaging catheter failed to access the appendiceal lumen. The loop-tipped guidewire was advanced through the stenotic orifice using its rounded contour and hydrophilic coating to navigate mucosal folds ([Video 1]). The disposable imaging catheter (ClearPath; Micro-Tech, Nanjing, China) was then threaded over the guidewire into the appendiceal lumen ([Fig. 1] d, [Video 1]). Direct visualization confirmed extensive purulent debris ([Fig. 1] e), which was irrigated with metronidazole until clear effluent was observed. A 5 Fr × 5 cm single-pigtail plastic stent was then deployed for drainage ([Fig. 1] f).

Loop-tipped guidewire-assisted cannulation of disposable imaging catheter into appendiceal lumen for difficult endoscopic retrograde appendicitis therapy.Video 1

The patient had immediate postoperative pain relief, with discharge on Day 1. The stent passed spontaneously by Day 4, and 2-week follow-up confirmed complete symptom resolution.

The loop-tipped guidewire displaces mucosa to create a catheter advancement track, minimizing trauma. Its hydrophilic coating and loop design reduce mucosal adhesion in tortuous/inflamed anatomy, guiding the imaging catheter to complete appendiceal cannulation. The simplicity, safety, and efficiency of the technique warrant broader clinical adoption.

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Publikationsverlauf

Artikel online veröffentlicht:
17. Juli 2025

• References

• 1 Ullah S, Ali FS, Liu BR. Management of acute uncomplicated appendicitis. JAMA Surg 2023; 158: 328
• 2 Wang F, Zhou XR, Zhang Y. et al. Digital single-operator cholangioscopy-guided appendiceal intubation for endoscopic retrograde appendicitis therapy in a pregnant woman (with video). Gastrointest Endosc 2023; 98: 1034-1035
• 3 Ullah S, Ali FS, Shi M. et al. Is it time for global adoption of endoscopic retrograde appendicitis therapy of acute appendicitis?. Clin Res Hepatol Gastroenterol 2022; 46: 102049