Evaluation of subepithelial lesion of the appendix by endoscopic ultrasound

Background: The use of through-the-scope (TTS) miniprobe catheter endoscopic ultrasound is a valuable technique for evaluating subepithelial lesions in the proximal colon. Few reports include the evaluation of the appendix by EUS.

Objective: To evaluate the performance characteristics of EUS in the diagnosis of periappendiceal subepithelial lesions.

Methods: Retrospective case series in a single academic medical center. Adult patients referred for evaluation of subepithelial lesions of the appendix identified by colonoscopy between January, 2004 to July, 2010. Data were abstracted from an endoscopic ultrasound database for all patients undergoing miniprobe endoscopic ultrasound examination of the appendix.

Results: Fifteen cases were identified. Nine (60%) patients were male. All cases were identified as asymptomatic subepithelial lesions of the appendix. EUS corrected presumptive endoscopic diagnosis in two cases (13%). A total of two cases were identified as being extrinsic compression of the small bowel. Presumptive diagnosis became to be certain in 10 cases (67%) after EUS exam. Surgery was needed in 5 cases on the basis of the presumptive EUS diagnosis. A total of 3 cases were confirmed histologically by surgery.

Conclusions: EUS evaluation can improve diagnostic certainty of subepithelial lesions of the appendix. Furthermore it may assist in the selection of patients who may benefit from surgical management in the patients with subepithelial lesions of the appendix