Appendiceal lesions are predominantly discovered incidentally during appendectomy
for other indications. Single-use cholangioscopes, used in the management of appendicitis
and diverticulitis, facilitate direct visualization of the appendix and diverticula
[1]
[2]. We present a case of a large appendiceal lesion, adeptly diagnosed via direct visualization
with a 9-Fr single-use cholangioscope (EyeMax, Micro-Tech, Nanjing, China) ([Video 1]).
Large sessile serrated lesion within the appendix, diagnosed utilizing a single-use
cholangioscope and removed by endoscopic transcecal appendectomy.Video 1
A 55-year-old female patient underwent colonoscopy for chronic constipation and was
found to have a whitish lesion encircling the appendiceal orifice, categorized as
0-IIa in the Paris classification and as type 1 in the Japan Narrow-band imaging Expert
Team (JNET) classification ([Fig. 1]). The lesion had a well-defined outer border, extending into the appendiceal lumen.
To assess the intraluminal extent of the lesion, a single-use cholangioscope was successfully
introduced into the appendiceal lumen ([Fig. 2]). With water immersion, the lesion manifested as a well-defined, whitish, villiform
elevation, encircling the lumen, and proximal to the appendix base. The inner border
of the lesion was distinctly demarcated ([Fig. 3]). Computed tomography revealed a normal appendix. Following consultation with the
patient, endoscopic transcecal appendectomy was performed ([Fig. 4]). Postoperative pathological examination confirmed a sessile serrated lesion (SSL),
characterized by distorted serrated crypts, deep crypt serration, and basal crypt
dilation ([Fig. 5]). The patient experienced mild abdominal pain and low grade fever after surgery
but recovered quickly with antibiotic treatment and was discharged on the 5th postoperative
day.
Fig. 1 Colonoscopy revealed a whitish lesion encircling the appendiceal orifice, categorized
as 0-IIa in the Paris classification and as type 1 in the Japan Narrow-band imaging
Expert Team (JNET) classification.
Fig. 2 A cholangioscope was inserted into the appendiceal lumen to further assess the intraluminal
extent of the lesion.
Fig. 3 The inner border of the lesion was distinctly demarcated.
Fig. 4 The removed appendix.
Fig. 5 Postoperative pathological examination confirmed a sessile serrated lesion.
SSLs are most commonly found in the right-sided colon and may extend into the appendix
[3]. However, diagnosing lesions involving the appendiceal lumen is challenging, as
colonoscopy cannot adequately visualize the full extent of these lesions. This case
represents the first instance of utilization of a single-use cholangioscope to directly
confirm SSL involvement of the appendix, followed by complete endoscopic resection,
and offers a valuable reference for the clinical management of similar conditions.
Endoscopy_UCTN_Code_TTT_1AQ_2AD_3AF
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