Appendicular Polyps: A single Centre case series and review of literature

Aims To describe the clinical presentation, management, and outcomes of a series of patients with appendicular polyps in our NHS Trust.

Methods This is a retrospective observational study of 26 patients with appendicular polyps. Data on demographics, clinical indications for colonoscopy, treatment modalities, histological findings, complications, and follow-up outcomes were collected. Descriptive statistics were utilised for data analysis.

Results NHS Bowel Cancer Screening Programme positive FIT was the most common indication for colonoscopy (26.9%); other indications were iron deficiency anaemia, weight loss, diarrhoea with raised calprotectin, abnormal imaging and constipation. The mean polyp size was 14mm (SD=11.07 mm), with 92.3% of patients having a single appendicular polyp. All 26 cases were discussed in our polyp multidisciplinary meeting (MDT), comprising interventional Endoscopists, Surgeons and a radiologist. 46.15% of the cases were managed endoscopically including EMR (10 patients), Cold snare polypectomy (2 patients) and 23% were managed surgically for those with complex polyp size or high suspicious polyp based on MDT discussion included appendicectomy (4 patients), right hemicolectomy; (2 patients). Eight patients were managed conservatively. Histopathological analysis revealed that 12 polyps were sessile serrated lesions without dysplasia, 5 were low-grade tubulovillous adenoma (TVA), 4 were low-grade tubular adenomas, 2 were hyperplastic polyps, one was a high-grade TVA, and the 2 resection specimens reported normal tissue. Seventeen patients received no follow-up; reasons included poor general condition with severe comorbidities, presence of advanced cancer in another site and patient preference. Of the 9 patients that were followed up, median follow-up was 6 months (range 3 months to 3 years); none had endoscopic recurrence. One possible complication was reported: appendicitis presenting 3 months post-polypectomy, which required appendicectomy.

Conclusions Appendicular polyps are histopathologically diverse. Although resection can be challenging, with appropriate expertise and multidisciplinary decision-making, most lesions can be curatively managed endoscopically.

Publication History

Article published online:
27 March 2025