Published online May 16, 2023. doi: 10.4253/wjge.v15.i5.386
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
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.
However, there is still limited published data investigating EMR and ESD for appendiceal polyps in the Western population.
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.
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.
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.
In conclusion, EMR and ESD are efficacious and safe techniques for large appendiceal orifice polyp removal.
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.