Yervant Ichkhanian1,2, Mohammed Barawi3, Talal Seoud4, Shyam Thakkar4, Truptesh H Kothari5, Maan El Halabi6, Asad Ullah7, Wedi Edris7, Patrick Aepli8, Thomas Kowalski9, Brianna Shinn9, Reem Z Shariaha10, Srihari Mahadev10, Jeffrey D Mosko11, Gianluca Andrisani12, Francesco Maria Di Matteo12, Heinz Albrecht13, Andrew Q Giap14, Shou-Jiang Tang15, Yehia M Naga15, Erwin van Geenen16, Shai Friedland17, Benjamin Tharian18, Shayan Irani19, Andrew S Ross19, Laith H Jamil20,21, Daniel Lew22, Andrew S Nett23, Jad Farha1, Thomas M Runge1,24, Manol Jovani1, Mouen A Khashab1. 1. Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA. 2. Department of Medicine, Henry Ford Hospital, Detroit, Michigan, USA. 3. Division of Gastroenterology and Hepatology, Ascension St. John Hospital, Detroit, Michigan, USA. 4. Center for Advanced Endoscopy, Allegheny Health Network, Pittsburgh, Pennsylvania, USA. 5. Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, New York, USA. 6. Department of Internal Medicine, Mount Sinai West, New York, New York, USA. 7. Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum, Offenbach, Germany. 8. Department of Gastroenterology and Hepatology, Luzerner Kantonsspital, Luzerne, Switzerland. 9. Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA. 10. Division of Gastroenterology and Hepatology, Weill Cornell Medicine/New York, Presbyterian Hospital, New York, New York, USA. 11. The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. 12. Digestive Endoscopy Unit, Campus Bio-Medico, University of Rome, Rome, Italy. 13. Department of Medicine, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany. 14. Department of Gastroenterology, Kaiser Permanente, Anaheim, California, USA. 15. Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA. 16. Radboud University Medical Center, Nijmegen, The Netherlands. 17. Division of Gastroenterology, Department of Medicine, Stanford University, Stanford, California, USA. 18. Department of Gastroenterology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. 19. Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA. 20. Section of Gastroenterology and Hepatology, Beaumont Health-Royal Oak, Royal Oak, Michigan, USA. 21. Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA. 22. Pancreatic and Biliary Diseases Program, Cedars-Sinai Medical Center, West Hollywood, California, USA. 23. Division of Gastroenterology, Sutter Health, Sacramento, California, USA. 24. Division of Gastroenterology and Hepatology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Abstract
BACKGROUND: Endoscopic resection of lesions involving the appendiceal orifice remains a challenge. We aimed to report outcomes with the full-thickness resection device (FTRD) for the resection of appendiceal lesions and identify factors associated with the occurrence of appendicitis. METHODS: This was a retrospective study at 18 tertiary-care centers (USA 12, Canada 1, Europe 5) between November 2016 and August 2020. Consecutive patients who underwent resection of an appendiceal orifice lesion using the FTRD were included. The primary outcome was the rate of R0 resection in neoplastic lesions, defined as negative lateral and deep margins on post-resection histologic evaluation. Secondary outcomes included the rates of: technical success (en bloc resection), clinical success (technical success without need for further surgical intervention), post-resection appendicitis, and polyp recurrence. RESULTS: 66 patients (32 women; mean age 64) underwent resection of colonic lesions involving the appendiceal orifice (mean [standard deviation] size, 14.5 (6.2) mm), with 40 (61 %) being deep, extending into the appendiceal lumen. Technical success was achieved in 59/66 patients (89 %), of which, 56 were found to be neoplastic lesions on post-resection pathology. Clinical success was achieved in 53/66 (80 %). R0 resection was achieved in 52/56 (93 %). Of the 58 patients in whom EFTR was completed who had no prior history of appendectomy, appendicitis was reported in 10 (17 %), with six (60 %) requiring surgical appendectomy. Follow-up colonoscopy was completed in 41 patients, with evidence of recurrence in five (12 %). CONCLUSIONS: The FTRD is a promising non-surgical alternative for resecting appendiceal lesions, but appendicitis occurs in 1/6 cases. Thieme. All rights reserved.
BACKGROUND: Endoscopic resection of lesions involving the appendiceal orifice remains a challenge. We aimed to report outcomes with the full-thickness resection device (FTRD) for the resection of appendiceal lesions and identify factors associated with the occurrence of appendicitis. METHODS: This was a retrospective study at 18 tertiary-care centers (USA 12, Canada 1, Europe 5) between November 2016 and August 2020. Consecutive patients who underwent resection of an appendiceal orifice lesion using the FTRD were included. The primary outcome was the rate of R0 resection in neoplastic lesions, defined as negative lateral and deep margins on post-resection histologic evaluation. Secondary outcomes included the rates of: technical success (en bloc resection), clinical success (technical success without need for further surgical intervention), post-resection appendicitis, and polyp recurrence. RESULTS: 66 patients (32 women; mean age 64) underwent resection of colonic lesions involving the appendiceal orifice (mean [standard deviation] size, 14.5 (6.2) mm), with 40 (61 %) being deep, extending into the appendiceal lumen. Technical success was achieved in 59/66 patients (89 %), of which, 56 were found to be neoplastic lesions on post-resection pathology. Clinical success was achieved in 53/66 (80 %). R0 resection was achieved in 52/56 (93 %). Of the 58 patients in whom EFTR was completed who had no prior history of appendectomy, appendicitis was reported in 10 (17 %), with six (60 %) requiring surgical appendectomy. Follow-up colonoscopy was completed in 41 patients, with evidence of recurrence in five (12 %). CONCLUSIONS: The FTRD is a promising non-surgical alternative for resecting appendiceal lesions, but appendicitis occurs in 1/6 cases. Thieme. All rights reserved.