Gastrointestinal endoscopy · 2025
Follow-up of 35 appendiceal orifice neoplasms resected by endoscopic full-thickness resection.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Cronin Oliver, Meys Kayla, Yuen Sofia, Vij Abhinav, Gonda Tamas, Goodman Adam J, Bourke Michael J, Haber Gregory B
Аннотация
BACKGROUND AND AIMS: Endoscopic full-thickness resection (EFTR) is an established, safe technique for the resection of appendiceal orifice (AO) neoplasms. Post-EFTR appendicitis is a recognized adverse event. There are no systematic reviews, and there is a paucity of literature with assessed outcomes, particularly with respect to delayed appendicitis, mucocele, or fistula formation. We aimed to evaluate the efficacy of EFTR for AO lesions.
METHODS: Consecutive AO lesions referred for consideration of EFTR were prospectively studied. Multiple data points were recorded including technical success, EFTR histopathologic data, adverse events, and follow-up surveillance data via colonoscopy. Surveillance CT was performed because of concerns of potential mucocele from the obstructed remnant appendix.
RESULTS: Over a 4-year period, starting from July 2019 till July 2023, 37 AO lesions were referred to a tertiary center for consideration of EFTR. EFTR was attempted in 35 (95%) lesions. Most lesions were small (median size 10 mm, interquartile range [IQR] 10-15 mm), exhibiting Paris 0-IIa morphology (n = 32, 91%) with serrated histopathology n = 17, 49%). R0 resection was achieved in most EFTR cases (n = 30/35, 86%). Adverse events included appendicitis (n = 4, 11%) and delayed bleeding (n = 2, 6%). At 6-month (IQR 4-6 months) surveillance colonoscopy, there was 1 (3%) case of residual lesion. This was successfully treated endoscopically, confirmed on a second surveillance colonoscopy. There was 1 case of appendicitis of the remnant at 7 months. At surveillance CT abdomen/pelvis (median 15 months, IQR 7-37 months), 2 of 17 (12%) fistulas were identified. Both of these patients had presumed adhesions due to abdominal surgery before EFTR.
CONCLUSIONS: In conclusion, EFTR is an effective technique for the curative resection of select, small (<15 mm) Paris 0-IIa AO lesions. Appendicitis is a relatively common adverse event but is often managed conservatively. The long-term significance of post-EFTR fistulas remains unclear. Caution should be exercised when considering EFTR in a patient with prior regional surgery.
METHODS: Consecutive AO lesions referred for consideration of EFTR were prospectively studied. Multiple data points were recorded including technical success, EFTR histopathologic data, adverse events, and follow-up surveillance data via colonoscopy. Surveillance CT was performed because of concerns of potential mucocele from the obstructed remnant appendix.
RESULTS: Over a 4-year period, starting from July 2019 till July 2023, 37 AO lesions were referred to a tertiary center for consideration of EFTR. EFTR was attempted in 35 (95%) lesions. Most lesions were small (median size 10 mm, interquartile range [IQR] 10-15 mm), exhibiting Paris 0-IIa morphology (n = 32, 91%) with serrated histopathology n = 17, 49%). R0 resection was achieved in most EFTR cases (n = 30/35, 86%). Adverse events included appendicitis (n = 4, 11%) and delayed bleeding (n = 2, 6%). At 6-month (IQR 4-6 months) surveillance colonoscopy, there was 1 (3%) case of residual lesion. This was successfully treated endoscopically, confirmed on a second surveillance colonoscopy. There was 1 case of appendicitis of the remnant at 7 months. At surveillance CT abdomen/pelvis (median 15 months, IQR 7-37 months), 2 of 17 (12%) fistulas were identified. Both of these patients had presumed adhesions due to abdominal surgery before EFTR.
CONCLUSIONS: In conclusion, EFTR is an effective technique for the curative resection of select, small (<15 mm) Paris 0-IIa AO lesions. Appendicitis is a relatively common adverse event but is often managed conservatively. The long-term significance of post-EFTR fistulas remains unclear. Caution should be exercised when considering EFTR in a patient with prior regional surgery.