Endoscopic resection is a feasible and safe treatment option for appendiceal lesions: a 7-year experience from three Italian high-volume centers

Aims The endoscopic resection of appendiceal and peri-appendiceallesion is very challenging due to scope stability, cecum wall anatomy and risk of appendiceallumen occlusion. Cold-snare polypectomy (CSP) and endoscopic mucosal resection (EMR) are the standard endoscopic techniques to treat these lesions, however in expert centersadvanced procedures have been described (eg. full-thickness resection-FTR-and endoscopic submucosal dissection-ESD-). Here, we reported the experiences of three Italian expert centers.

Methods This is a multicentric retrospective observational study including 3 high-volume Italian endoscopic centers. Patients with appendiceal or periappendiceal lesions treated withendoscopic resection between 2017 and 2024 were retrospectively included in the study.Demographics, technical data, success rate, and AEs were recorded [1] [2].

Results We enrolled 64 patients, demographic data in Table 1. The mean lesion size was 26 mm (range 10-70 mm), 72% of lesions involved both cecum and appendiceal orifice while 28% involved the appendiceal orifice only. The endoscopic techniques performed were EMRin 33%, underwater-EMR in 20%, FTR in 19%, ESD in 19%, and Hybrid techniques in 9% ofcases. Previous appendectomy was reported in 20% of patients. The en-bloc resection ratewas 92% in ESD (the only case of incomplete resection was referred to surgery for pT1bcancer), 52% in EMR, 62% in underwater-EMR, 100% in FTR, and 83% in Hybridtechniques. ESD was associated with a higher en-bloc resection rate (p-value 0.007). AEswere reported in 15% of cases: 3 delayed bleedings (all managed endoscopically), 6intraoperative perforations (all managed endoscopically), and 1 delayed perforation requiring surgery. Previous appendectomy was not associated with increased risk of perforation (p-value 0.9). One case of acute appendicitis was reported. Surgery was required in two cases for non-curative resection.

Conclusions Endoscopic resection of appendiceal and peri-appendiceal lesions is feasible,effective and relatively safe when performed in expert centers. ESD was associated with ahigher en-bloc resection rate. Previous appendectomy didn’t change the final outcome.

Publication History

Article published online:
27 March 2025

• References

• 1 Estevinho MM, Rodrigues J, Pinho R, Correia J, Freitas T.. Endoscopic full-thickness resection of two appendicular lesions: hybrid and conventional approaches. Eur J Gastroenterol Hepatol 2022; 34 (12): 1285-1286 Epub 2022 Oct 26. PMID: 36317775.
• 2 Figueiredo M, Yzet C, Wallenhorst T, Rivory J, Rostain F, Schaefer M, Chevaux JB, Leblanc S, Lépilliez V, Corre F, Rahmi G, Jacques J, Albouys J, Pioche M.. Endoscopic submucosal dissection of appendicular lesions is feasible and safe: a retrospective multicenter study (with video). Gastrointest Endosc 2023; 98 (04): 634-638 Epub 2023 Jun 26 PMID: 37380005