Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. May 16, 2023; 15(5): 386-396
Published online May 16, 2023. doi: 10.4253/wjge.v15.i5.386
Expanding endoscopic boundaries: Endoscopic resection of large appendiceal orifice polyps with endoscopic mucosal resection and endoscopic submucosal dissection
Ankur P Patel, Mai A Khalaf, Margarita Riojas-Barrett, Tara Keihanian, Mohamed O Othman
Ankur P Patel, Department of Internal Medicine, Baylor College of Medicine, Houston, TX 77030, United States
Mai A Khalaf, Department of Tropical Medicine, Tanta University, Tanta 31527, Egypt
Margarita Riojas-Barrett, Tara Keihanian, Mohamed O Othman, Department of Gastroenterology, Baylor College of Medicine, Houston, TX 77030, United States
Author contributions: Patel AP collected the data, analyzed and interpreted the data, drafted the manuscript, and performed statistical analysis; Khalaf MA and Riojas-Barrett M collected the data; Keihanian T collected the data, analyzed and interpreted the data, performed statistical analysis, and revised the manuscript; Othman MO created the study design, revised the manuscript, and supervised the study; all authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Baylor College of Medicine Institutional Review Board (Approval Number: H-50836).
Informed consent statement: A waiver of consent was obtained from the Baylor College of Medicine Institutional Review Board.
Conflict-of-interest statement: Tara Keihanian has received fees for serving as a consultant for Lumendi and Neptune Medical. Mohamed O Othman has received fees for serving as a consultant for Olympus America, Abbvie, Boston Scientific Corporation, Lumendi, Apollo, Conmed, and Medtronic. Mohamed O Othman has received research funding from Olympus America, Abbvie, Boston Scientific Corporation, and US Biotest.
Data sharing statement: The dataset is available from the corresponding author at mohamed.othman@bcm.edu. Consent was not obtained but the presented data are anonymized and the risk of identification is low.
STROBE statement: The authors have read the STROBE Statement - checklist of items, and the manuscript was prepared and revised accordingly.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohamed O Othman, MD, Chief Physician, Professor, Department of Gastroenterology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States. mohamed.othman@bcm.edu
Received: February 17, 2023
Peer-review started: February 17, 2023
First decision: March 28, 2023
Revised: April 10, 2023
Accepted: April 18, 2023
Article in press: April 18, 2023
Published online: May 16, 2023
ARTICLE HIGHLIGHTS
Research background

Appendiceal orifice polyps are often referred for surgical resection. More recently, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have been considered by expert advanced endoscopists for the removal of complex appendiceal polyps.

Research motivation

However, there is still limited published data investigating EMR and ESD for appendiceal polyps in the Western population.

Research objectives

The main objective of this study is to evaluate the safety and efficacy of EMR and ESD for the management of complex appendiceal orifice polyps.

Research methods

This was a retrospective observation study involving adult patients who underwent endoscopic resection of appendiceal orifice polyps ≥ 1 cm by EMR, ESD, or hybrid EMR/ESD from 2015 to 2022 at Baylor St. Luke’s Medical Center. All procedures were performed by one advanced endoscopist experienced in endoscopic resection. Data collection included demographic information, polyp characteristics, procedure details, and procedure outcomes. The main outcomes of interest were en bloc resection rate, R0 resection rate, and adverse events.

Research results

A total of 19 patients were identified, with a mean polyp size of 25.5 ± 14.2 mm. The overall en bloc resection rate was 84%, with an R0 resection rate of 88% and no significant difference in between EMR, ESD, and hybrid EMR/ESD. 89% of patients were discharged on the same day as their procedure, with only two patients admitted conservatively post-procedure for pain management. Despite our larger overall polyp size, we observed high en bloc and R0 resection rates for EMR, ESD, and hybrid EMR/ESD procedures without any significant adverse effects.

Research conclusions

In conclusion, EMR and ESD are efficacious and safe techniques for large appendiceal orifice polyp removal.

Research perspectives

Future large, prospective trials can be conducted to demonstrate the safety and utility of EMR and ESD for the resection of complex appendiceal polyps. These studies can also incorporate both experienced and naïve endoscopists across multiple centers in the United States.