Endoscopy 2016; 48(09): 829-836
DOI: 10.1055/s-0042-110396
Original article
© Georg Thieme Verlag KG Stuttgart · New York

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

Harold Jacob
1  Department of Gastroenterology, Hadassah University Medical Center, Jerusalem, Israel
,
Takashi Toyonaga
2  Department of Endoscopy, Kobe University Hospital, Kobe, Japan
3  Department of Endoscopy, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Yoshiko Ohara
4  Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
,
Eiji Tsubouchi
3  Department of Endoscopy, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Hiroshi Takihara
3  Department of Endoscopy, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Shinichi Baba
3  Department of Endoscopy, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Tetsuya Yoshizaki
4  Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
,
Fumiaki Kawara
4  Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
,
Shinwa Tanaka
2  Department of Endoscopy, Kobe University Hospital, Kobe, Japan
,
Tsukasa Ishida
4  Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
,
Namiko Hoshi
4  Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
,
Yoshinori Morita
4  Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
,
Eiji Umegaki
4  Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
,
Takeshi Azuma
4  Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
› Author Affiliations
Further Information

Publication History

submitted 14 November 2015

accepted after revision 28 April 2016

Publication Date:
28 July 2016 (online)

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.