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CC BY 4.0 · Endoscopy 2025; 57(S 01): E84-E85
DOI: 10.1055/a-2512-3926
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Endoscopic transcecal appendectomy for a laterally spreading tumor of the appendiceal stump

Xin-Yue Li‡
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
,
Dan-Feng Zhang‡
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
,
Meng-Jiang He
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
,
Quan-Lin Li
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
,
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
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A 68-year-old woman, who was diagnosed with suppurative appendicitis 17 years previously and underwent appendectomy, was found during a recent colonoscopy, performed as part of a health-check, to have a 1.5-cm flat laterally spreading tumor (LST) at the appendiceal orifice ([Fig. 1] a). Biopsy indicated that the lesion was a tubular adenoma with low grade intraepithelial neoplasia (LGIN). Computed tomography revealed peristump exudation and pneumatosis. Endoscopic transcecal appendectomy (ETA) was recommended to remove the lesion at the appendiceal stump ([Video 1]).

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Fig. 1 Endoscopic images showing: a a laterally spreading tumor at the appendiceal orifice; b full-thickness resection around the lesion; c dissection of the appendiceal stump in the peritoneal cavity; d closure of the cecal defect using the purse-string suture technique.

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Endoscopic transcecal appendectomy is performed for a laterally spreading tumor of the appendiceal stump.Video 1

After submucosal injection had been performed and a circumferential incision made using a HookKnife, an IT Knife was used to perform a full-thickness resection around the lesion ([Fig. 1] b). The colonoscope was then introduced into the peritoneal cavity, where extensive tissue adhesions were seen, and we thoroughly dissected the appendiceal stump from the surrounding fibrous tissue ([Fig. 1] c). The appendiceal stump and the lesion were completely resected and extracted through the anus using a snare ([Fig. 2] a). After the wound had been cauterized with hot biopsy forceps and it had been confirmed that there was no active bleeding, the cecal wall defect was closed with 12 endoclips and a nylon loop ([Fig. 1] d). A nasogastric tube was fixed in the cecum for anal decompression using dental floss and an endoclip. The total procedure duration was 60 minutes. The patient was discharged on postoperative day 6, without having experienced any adverse events. Subsequent pathologic diagnosis confirmed chronic stump appendicitis and a localized tubular adenoma with LGIN ([Fig. 2] b).

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Fig. 2 Pathology of the resected specimens showed: a macroscopically, complete resection of the appendiceal stump and lesion (the base and the apex); b microscopically, chronic stump appendicitis and a localized tubular adenoma with low grade intraepithelial neoplasia.

ETA is a natural orifice transluminal endoscopic surgery, which has proved to be safe and effective for appendiceal orifice lesions [1]. In this case, ETA was advantageous because of the presence of peritoneal adhesions from the prior surgery, as it facilitated control during resection and avoided the need for a second surgical intervention. Recently, we have also reported a similar case of ETA for stump appendicitis [2], and clinical studies in larger cohorts with long-term follow-up are warranted to evaluate the safety and efficacy of ETA in patients who have previously undergone appendectomy.

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Artikel online veröffentlicht:
31. Januar 2025

© 2025. 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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