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CC BY 4.0 · Endoscopy 2024; 56(S 01): E642-E643
DOI: 10.1055/a-2357-2483
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Transcolonic endoscopic appendectomy via snare-through-line resection for stump appendicitis

Yun Wang‡
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital Fudan University, Shanghai, China (Ringgold ID: RIN92323)
2   Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
,
Ming-Yan Cai‡
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital Fudan University, Shanghai, China (Ringgold ID: RIN92323)
2   Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
,
Sheng-Li Lin
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital Fudan University, Shanghai, China (Ringgold ID: RIN92323)
2   Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
,
Mo-Fan Li
3   Nursing Department, Zhongshan Hospital Fudan University, Shanghai, China (Ringgold ID: RIN92323)
,
Ping-Hong Zhou
1   Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital Fudan University, Shanghai, China (Ringgold ID: RIN92323)
2   Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
› Author Affiliations
Supported by: Outstanding Youth Foundation of Zhongshan Hospital, Fudan University 202ZSYQ12
Supported by: Yangfan Program of Shanghai Municipal Science and Technology Committee 21YF1440100
Supported by: National Natural Science Foundation of China 82000623
Supported by: Major Project of Shanghai Municipal Science and Technology Committee 23ZR1445500
› Further Information
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A 16-year-old girl was admitted due to recurrent abdominal pain 10 months after laparoscopic appendectomy. Physical examination showed tenderness at the McBurney point. Computed tomography revealed a distended appendiceal stump with peristump inflammation and dense suture material at the ligated end. After comprehensive preoperative assessment, transcolonic endoscopic appendectomy was chosen.

Following submucosal injection, a hook knife was employed to create a mucosal incision and perform partial dissection of the submucosal layer, succeeded by full-thickness resection with an IT knife ([Fig. 1], [Video 1]). The endoscope was advanced into the peritoneal cavity, revealing a dilated appendiceal remnant with fibrous adhesions. The adhesions encircling the appendiceal stump were loosened by blunt dissection or with the IT knife. A clip with a 6–0 Prolene suture attached was mounted on the endoscope. The clip was then advanced with the endoscope and deployed at the end of the appendiceal stump. Next, a snare was inserted through the line and the working channel of the endoscope. Using the snare-through-line method, the appendiceal stump was completely resected. Mesenteric vessels were coagulated with hot biopsy forceps. The cecal defect was closed with a novel detachable over-the-scope clip (Senscure, China). The twin grasper facilitated precise alignment of the defect edges. A decompression tube was secured in the cecum with dental floss and an endoclip. The total procedure duration was 70 minutes. The patient had an uneventful recovery and was discharged 4 days after the procedure. Histopathology confirmed acute and chronic stump appendicitis.

Zoom Image
Fig. 1 Endoscopic images of transcolonic endoscopic appendectomy for stump appendicitis. a Appendiceal orifice. b Full-thickness resection around the appendiceal orifice. C A dilated appendiceal stump with suture line from the first appendectomy. d Snare-through-line resection of the appendiceal stump. e Defect closure with a novel detachable over-the-scope clip. f The resected appendiceal stump.

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Transcolonic endoscopic appendectomy via snare-through-line resection for stump appendicitis.Video 1

Stump appendicitis is a rare late complication after appendectomy, with an incidence presumed to be between 0.002% and 0.15% [1] [2]. Using the snare-through-line method, we successfully performed endoscopic resection for stump appendicitis, expanding the horizon of natural orifice transluminal endoscopic surgery. Further clinical studies and long-term follow-ups are warranted to substantiate the safety and efficacy of this procedure.

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Conflict of Interest

The authors declare that they have no conflict of interest.


Correspondence

Ping-Hong Zhou, MD, FASGE
Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University
Shanghai
China   

Publication History

Article published online:
26 July 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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Zoom Image
Fig. 1 Endoscopic images of transcolonic endoscopic appendectomy for stump appendicitis. a Appendiceal orifice. b Full-thickness resection around the appendiceal orifice. C A dilated appendiceal stump with suture line from the first appendectomy. d Snare-through-line resection of the appendiceal stump. e Defect closure with a novel detachable over-the-scope clip. f The resected appendiceal stump.