Endoscopic retrograde appendicitis therapy (ERAT) is an emerging minimally invasive
approach for the diagnosis and treatment of acute appendicitis [1]. The disposable imaging catheter provides direct visualization of the appendiceal
lumen, enabling irrigation, fecalith removal, and stent placement [2]. Similarly to endoscopic retrograde cholangiopancreatography (ERCP), cannulation
in ERAT remains challenging due to edematous or stenotic appendiceal orifices [3]. This report describes a novel technique using a loop-tipped guidewire to guide
a disposable imaging catheter to the appendiceal orifice during difficult intubation,
facilitating successful cannulation.
A 24-year-old man with a 5-day history of right lower quadrant pain declined surgery
in favor of conservative management. Computed tomography showed appendiceal dilation
(14 mm) with peri-appendiceal inflammation ([Fig. 1]
a). ERAT was proposed as an alternative therapeutic approach.
Fig. 1 Loop-tipped guidewire-assisted cannulation of disposable imaging catheter into the
appendiceal lumen. a Computed tomography showing dilated appendix (14 mm). b Loop-tipped guidewire modification. c Edematous appendiceal orifice on colonoscopy. d Successful catheter cannulation. e Endoscopic view of purulent debris. f Deployed single-pigtail stent.
A standard ERCP guidewire (Jagwire; Boston Scientific, Marlborough, Massachusetts,
USA) was manually shaped to form a loop at its tip ([Fig. 1]
b). Colonoscopy identified a severely edematous and hyperemic appendiceal orifice ([Fig. 1]
c). The disposable imaging catheter failed to access the appendiceal lumen. The loop-tipped
guidewire was advanced through the stenotic orifice using its rounded contour and
hydrophilic coating to navigate mucosal folds ([Video 1]). The disposable imaging catheter (ClearPath; Micro-Tech, Nanjing, China) was then
threaded over the guidewire into the appendiceal lumen ([Fig. 1]
d, [Video 1]). Direct visualization confirmed extensive purulent debris ([Fig. 1]
e), which was irrigated with metronidazole until clear effluent was observed. A 5 Fr
× 5 cm single-pigtail plastic stent was then deployed for drainage ([Fig. 1]
f).
Loop-tipped guidewire-assisted cannulation of disposable imaging catheter into appendiceal
lumen for difficult endoscopic retrograde appendicitis therapy.Video 1
The patient had immediate postoperative pain relief, with discharge on Day 1. The
stent passed spontaneously by Day 4, and 2-week follow-up confirmed complete symptom
resolution.
The loop-tipped guidewire displaces mucosa to create a catheter advancement track,
minimizing trauma. Its hydrophilic coating and loop design reduce mucosal adhesion
in tortuous/inflamed anatomy, guiding the imaging catheter to complete appendiceal
cannulation. The simplicity, safety, and efficiency of the technique warrant broader
clinical adoption.
Endoscopy_UCTN_Code_TTT_1AT_2AF
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy.
All papers include a high-quality video and are published with a Creative Commons
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