Endoscopic imaging of the vermiform appendix (with video)

Area of Science:

• Gastroenterology
• Endoscopy
• Surgical Pathology

Background:

• Chronic appendicitis affects up to 10% of patients presenting with right lower quadrant pain.
• The appendiceal orifice is accessible during colonoscopy, but its lumen remains largely uninvestigated.
• Current diagnostic methods for chronic appendicitis may be limited.

Purpose of the Study:

• To assess the feasibility of endoscopic appendix imaging for diagnosing chronic appendicitis.
• To identify characteristic features of chronic appendicitis using endoscopic visualization.
• To evaluate the safety and clinical utility of this novel endoscopic approach.

Main Methods:

• A prospective, proof-of-concept study was conducted at a tertiary referral hospital.
• Colonoscopy patients with right lower quadrant pain underwent appendix orifice cannulation using a guidewire and Jagtome.
• Fluoroscopic imaging with contrast, followed by SpyGlass endoscopy and biopsy, was performed. Cannulation rate was the primary outcome measure.

Main Results:

• Endoscopic appendix imaging was successful in 69% (9/13) of patients.
• Histological signs of inflammation were found in 5 of 7 biopsy specimens.
• Fecoliths were removed in 4 patients, and 3 reported pain resolution post-procedure. No adverse events occurred.

Conclusions:

• Endoscopic imaging of the appendix is a feasible, safe, and potentially useful diagnostic tool.
• The procedure allows for direct visualization, biopsy, and therapeutic interventions like fecolith removal.
• Further studies with larger patient cohorts are needed to confirm these findings and establish the technique's full potential.