Gastrointestinal endoscopy · 2014
Endoscopic imaging of the vermiform appendix (with video).
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Ferlitsch Arnulf, Puespoek Andreas, Gasche Christoph
Аннотация
BACKGROUND: Chronic appendicitis may be detected in as many as 10% of patients with right lower quadrant pain. Although the appendiceal orifice is easily identified during colonoscopy, its lumen has not been investigated so far.
OBJECTIVES: To determine the feasibility of endoscopic appendix imaging to identify features of chronic appendicitis in patients with recurrent right lower quadrant pain.
DESIGN: Prospective, proof-of-concept study.
SETTING: University-based tertiary referral hospital.
PATIENTS: Colonoscopy scheduled because of right lower quadrant pain.
INTERVENTIONS: First, the appendix orifice was cannulated with a guidewire and a Jagtome. Next fluoroscopic imaging was performed by injection of contrast agent into the appendix orifice, and then a SpyGlass endoscope was inserted for imaging of the appendiceal mucosa and for biopsy. Patients were monitored 3 hours after investigation, with follow-up at 4 weeks.
MAIN OUTCOME MEASUREMENTS: Cannulation rate.
RESULTS: Thirteen patients were included. Endoscopic imaging of the appendix was successful in 9 of 13 patients (69%). In 10 patients, a guidewire was placed; in 7 patients, biopsy specimens were taken, revealing histological signs of inflammation in 5. In 4 patients, visible fecoliths were removed by flushing. All patients were discharged on the same day. No adverse events occurred. Three patients reported resolution of pain at follow-up. One patient with strictures at appendicoscopy underwent surgical appendectomy. Histology confirmed the findings of chronic appendicitis with fibrosis.
LIMITATIONS: Patient number limits power for analysis.
CONCLUSION: Endoscopic imaging of the appendix is feasible, safe, and clinically useful in patients with suspected chronic appendicitis.
OBJECTIVES: To determine the feasibility of endoscopic appendix imaging to identify features of chronic appendicitis in patients with recurrent right lower quadrant pain.
DESIGN: Prospective, proof-of-concept study.
SETTING: University-based tertiary referral hospital.
PATIENTS: Colonoscopy scheduled because of right lower quadrant pain.
INTERVENTIONS: First, the appendix orifice was cannulated with a guidewire and a Jagtome. Next fluoroscopic imaging was performed by injection of contrast agent into the appendix orifice, and then a SpyGlass endoscope was inserted for imaging of the appendiceal mucosa and for biopsy. Patients were monitored 3 hours after investigation, with follow-up at 4 weeks.
MAIN OUTCOME MEASUREMENTS: Cannulation rate.
RESULTS: Thirteen patients were included. Endoscopic imaging of the appendix was successful in 9 of 13 patients (69%). In 10 patients, a guidewire was placed; in 7 patients, biopsy specimens were taken, revealing histological signs of inflammation in 5. In 4 patients, visible fecoliths were removed by flushing. All patients were discharged on the same day. No adverse events occurred. Three patients reported resolution of pain at follow-up. One patient with strictures at appendicoscopy underwent surgical appendectomy. Histology confirmed the findings of chronic appendicitis with fibrosis.
LIMITATIONS: Patient number limits power for analysis.
CONCLUSION: Endoscopic imaging of the appendix is feasible, safe, and clinically useful in patients with suspected chronic appendicitis.