Endoscopic submucosal dissection of cecal lesions in proximity to the appendiceal orifice

Harold Jacob; Takashi Toyonaga; Yoshiko Ohara; Eiji Tsubouchi; Hiroshi Takihara; Shinichi Baba; Tetsuya Yoshizaki; Fumiaki Kawara; Shinwa Tanaka; Tsukasa Ishida; Namiko Hoshi; Yoshinori Morita; Eiji Umegaki; Takeshi Azuma

doi:10.1055/s-0042-110396

Endoscopy, Table of Contents

Endoscopy 2016; 48(09): 829-836
DOI: 10.1055/s-0042-110396

Original article

Endoscopic submucosal dissection of cecal lesions in proximity to the appendiceal orifice

Authors

Harold Jacob

¹Department of Gastroenterology, Hadassah University Medical Center, Jerusalem, Israel
Takashi Toyonaga

²Department of Endoscopy, Kobe University Hospital, Kobe, Japan

³Department of Endoscopy, Kishiwada Tokushukai Hospital, Kishiwada, Japan
Yoshiko Ohara

⁴Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
Eiji Tsubouchi

³Department of Endoscopy, Kishiwada Tokushukai Hospital, Kishiwada, Japan
Hiroshi Takihara

³Department of Endoscopy, Kishiwada Tokushukai Hospital, Kishiwada, Japan
Shinichi Baba

³Department of Endoscopy, Kishiwada Tokushukai Hospital, Kishiwada, Japan
Tetsuya Yoshizaki

⁴Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
Fumiaki Kawara

⁴Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
Shinwa Tanaka

²Department of Endoscopy, Kobe University Hospital, Kobe, Japan
Tsukasa Ishida

⁴Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
Namiko Hoshi

⁴Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
Yoshinori Morita

⁴Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
Eiji Umegaki

⁴Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
Takeshi Azuma

⁴Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan

Abstract

Background and study aims: Endoscopic submucosal dissection (ESD) is performed for treatment of various gastrointestinal lesions; however, the cecum in proximity to the appendiceal orifice remains a challenging area. We reviewed our experience with cecal ESD near the appendiceal orifice in order to clarify whether this procedure is a safe and effective therapeutic option.

Patients and methods: We retrospectively reviewed ESD for lesions within approximately 12 mm of the appendiceal orifice at Kobe University Hospital and an affiliated hospital between January 2003 and December 2014. Lesions were classified as: Type 0, proximity to the appendiceal orifice but does not reach it; Type 1, reaches border of the appendix, but does not enter orifice; Type 2, enters orifice, and transition to normal appendiceal mucosa is discernible on inspection of the appendiceal lumen; and Type 3, enters orifice deeply and tumor edge cannot be observed. ESD was not performed for Type 3 lesions unless appendectomy was performed prior to ESD.

Results: A total of 76 lesions satisfied the inclusion criteria (47 Type 0 lesions, 20 Type 1, 6 Type 2, and 3 Type 3). En bloc resection was achieved in 72 lesions (94.7 %). Median specimen size was 49 mm (range 15 – 114 mm), and median tumor size was 35.5 mm (10 – 110 mm). One patient experienced postoperative bleeding, which was treated by endoscopic hemostasis. Another patient who experienced intraoperative perforation and was treated by clip closure later developed appendicitis; he underwent emergency ileocecal surgical resection. Another patient experienced postoperative appendicitis and recovered with antibiotic treatment.

Conclusions: ESD in close proximity to the appendiceal orifice seems safe and effective.

Full Text

References

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