Eun Mi Song1, Hyo-Joon Yang2, Hyun Jung Lee3, Hyun Seok Lee4, Jae Myung Cha5, Hyun Gun Kim6, Yunho Jung7, Chang Mo Moon8, Byung Chang Kim9, Jeong-Sik Byeon10. 1. Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. 2. Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. 3. Division of Gastroenterology and Institute of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. 4. Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea. 5. Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, Korea. 6. Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea. 7. Division of Gastroenterology, Department of Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea. 8. Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea. 9. Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea. 10. Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. jsbyeon@amc.seoul.kr.
Abstract
BACKGROUND: Endoscopic resection of polyps located at the appendiceal orifice (AO) is challenging, and the feasibility and outcomes of endoscopic resection for cecal polyps involving AO are unconfirmed. AIMS: We evaluated the feasibility and outcomes of endoscopic resection for cecal polyps involving AO. METHODS: In this retrospective, multicenter study involving nine tertiary referral centers, we evaluated 131 patients who underwent endoscopic resection for cecal polyps involving AO. RESULTS: The median size of polyps resected was 10 mm (range 3-60 mm). Endoscopic mucosal resection, endoscopic piecemeal mucosal resection, and endoscopic submucosal dissection were performed in 75 (57.3%), 31 (23.7%), and 5 (3.8%) patients, respectively. The en bloc resection rate was 68.7%. Endoscopic complete resection was achieved in 123 lesions (93.9%). Intraprocedural and delayed bleeding occurred in 14 (10.7%) and three patients (2.3%), respectively, and perforation occurred in two patients (1.5%). Seven patients (5.3%) underwent additional surgery because of treatment failure or recurrence. Polyps of ≥20 mm in size showed significantly higher rates of perforation and additional surgery (p < 0.05), and a lower rate of en bloc resection (p < 0.005). Patients with polyps involving ≥75% of AO circumference exhibited a significantly lower rate of en bloc resection (p < 0.001), and significantly higher rates of surgery and recurrence (p < 0.05). Recurrence during follow-up occurred in 12 patients (15.6%); polyps involving ≥75% of AO circumference were an independent risk factor for recurrence. CONCLUSION: Endoscopic resection of cecal polyps involving AO is safe and effective in select patients.
BACKGROUND: Endoscopic resection of polyps located at the appendiceal orifice (AO) is challenging, and the feasibility and outcomes of endoscopic resection for cecal polyps involving AO are unconfirmed. AIMS: We evaluated the feasibility and outcomes of endoscopic resection for cecal polyps involving AO. METHODS: In this retrospective, multicenter study involving nine tertiary referral centers, we evaluated 131 patients who underwent endoscopic resection for cecal polyps involving AO. RESULTS: The median size of polyps resected was 10 mm (range 3-60 mm). Endoscopic mucosal resection, endoscopic piecemeal mucosal resection, and endoscopic submucosal dissection were performed in 75 (57.3%), 31 (23.7%), and 5 (3.8%) patients, respectively. The en bloc resection rate was 68.7%. Endoscopic complete resection was achieved in 123 lesions (93.9%). Intraprocedural and delayed bleeding occurred in 14 (10.7%) and three patients (2.3%), respectively, and perforation occurred in two patients (1.5%). Seven patients (5.3%) underwent additional surgery because of treatment failure or recurrence. Polyps of ≥20 mm in size showed significantly higher rates of perforation and additional surgery (p < 0.05), and a lower rate of en bloc resection (p < 0.005). Patients with polyps involving ≥75% of AO circumference exhibited a significantly lower rate of en bloc resection (p < 0.001), and significantly higher rates of surgery and recurrence (p < 0.05). Recurrence during follow-up occurred in 12 patients (15.6%); polyps involving ≥75% of AO circumference were an independent risk factor for recurrence. CONCLUSION: Endoscopic resection of cecal polyps involving AO is safe and effective in select patients.
Authors: Kenneth F Binmoeller; Chris M Hamerski; Janak N Shah; Yasser M Bhat; Steven D Kane Journal: Gastrointest Endosc Date: 2015-09-14 Impact factor: 9.427
Authors: I Sakamoto; S Watanabe; T Sakuma; M Igarashi; J Koike; T Shirai; S Sadahiro; M Nakamura; T Mine Journal: Endoscopy Date: 2003-09 Impact factor: 10.093