ENDOSCOPIC RESECTION OF COLORECTAL POLYPS INVOLVING THE APPENDICEAL ORIFICE: A SPECIALIST APPROACH TO A UNIQUE POLYP SUBTYPE

Aims To describe characteristics, endoscopic management techniques and outcomes for a series of appendiceal orifice (AO) polyps.

Methods This was a retrospective review of a prospectively maintained database of AO polyps managed by endoscopic mucosal resection (EMR) at two high-volume academic centres. Resection technique was not standardised across centres. Polyps were described using Jacob classification.

Results The case series includes 16 patients, median age of 66 years (range 43-85 years). Polyps divided equally between protruded lesions and flat elevated lesions and equally between adenomas and sessile serrated lesions. The majority of polyps (n=16, 81.25%) were Jacob Type 2 and the remainder were Type 0 (n=3, 18.75%). Piecemeal cold EMR, traditional EMR and en bloc EMR were performed in 43.75%, 37.5% and 18.75% of cases respectively. Snare tip soft coagulation (STSC) was applied in n=6 (37.5%) of cases and clips were used in n=6 (37.5%). The only complication reported was intra-procedural bleeding (IPB) in one case. Of the 15 patients who had at least one site check performed, two (13.3%) had recurrence not amenable to endoscopic resection and were referred for surgery. Another three (19.9%) had recurrence cleared endoscopically at first site check. The total recurrence rate after first site check was 13.3%.

Conclusions Overall, recurrence and complication rates were in keeping with previous series. Post-resection clip application was used sparingly. This may have been due to concerns about appendicitis and is supported by absence of any case of post-resection appendicitis. A standardised approach to endoscopic reporting, polyp characterisation and resection should be encouraged.

Publication History

Article published online:
14 April 2022