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
Abstract
BACKGROUND

Large appendiceal orifice polyps are traditionally treated surgically. Recently, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have been utilized as alternative resection techniques.

AIM

To evaluate the efficacy and safety of endoscopic resection techniques for the management of large appendiceal orifice polyps.

METHODS

This was a retrospective observational study conducted to assess the feasibility and safety of EMR and ESD for large appendiceal orifice polyps. This project was approved by the Baylor College of Medicine Institutional Review Board. Patients who underwent endoscopic resection of appendiceal orifice polyps ≥ 1 cm from 2015 to 2022 at a tertiary referral endoscopy center in the United States were enrolled. The main outcomes of this study included en bloc resection, R0 resection, post resection adverse events, and polyp recurrence.

RESULTS

A total of 19 patients were identified. Most patients were female (53%) and Caucasian (95%). The mean age was 63.3 ± 10.8 years, and the average body mass index was 28.8 ± 6.4. The mean polyp size was 25.5 ± 14.2 mm. 74% of polyps were localized to the appendix (at or inside the appendiceal orifice) and the remaining extended into the cecum. 68% of polyps occupied ≥ 50% of the appendiceal orifice circumference. The mean procedure duration was 61.6 ± 37.9 minutes. Polyps were resected via endoscopic mucosal resection, endoscopic submucosal dissection, and hybrid procedures in 5, 6, and 8 patients, respectively. Final pathology was remarkable for tubular adenoma (n = 10) [one with high grade dysplasia], sessile serrated adenoma (n = 7), and tubulovillous adenoma (n = 2) [two with high grade dysplasia]. En bloc resection was achieved in 84% with an 88% R0 resection rate. Despite the large polyp sizes and challenging procedures, 89% (n = 17) of patients were discharged on the same day as their procedure. Two patients were admitted for post-procedure observation for conservative pain management. Eight patients underwent repeat colonoscopy without evidence of residual or recurrent adenomatous polyps.

CONCLUSION

Our study highlights how endoscopic mucosal resection, endoscopic submucosal dissection, and hybrid procedures are all appropriate techniques with minimal adverse effects, further validating the utility of endoscopic procedures in the management of large appendiceal polyps.

Keywords: Appendiceal orifice polyps, Endoscopic mucosal resection, Endoscopic submucosal dissection, Polyp resection, Adenomatous polyps, En bloc resection

Core Tip: In this study, we evaluated endoscopic mucosal resection, endoscopic submucosal dissection, and hybrid procedures for the resection of large appendiceal polyps. Compared to previously published studies, we noticed a higher en bloc resection rate and R0 resection rate in our study, despite a larger polyp size. Our data supported these procedures as safe and efficacious for the management of large polyps in a challenging location such as the appendiceal orifice, with minimal to no adverse events.