"Obscure" Appendiceal Orifice Polyps Can Be Challenging to Identify by Colonoscopy

Area of Science:

• Gastroenterology
• Endoscopy
• Oncology

Background:

• Screening colonoscopy aims to detect and remove precancerous polyps.
• Recognizing appendiceal lesions with standard endoscopes is challenging, often limited to the cecal base and appendiceal orifice.

Observation:

• Appendiceal polyps are usually found incidentally after appendectomy.
• Colonoscopy can visualize appendiceal polyps, but they are often referred for surgical resection.
• Three cases are presented where appendiceal orifice polyps were initially missed but later protruded into the cecum after prolonged examination and cecal deflation.

Findings:

• The risk of carcinoma in appendiceal polyps is comparable to colonic polyps.
• Thorough examination of the appendiceal orifice is essential for endoscopists.
• Techniques like luminal inflation/deflation and examining behind folds can improve visualization.

Implications:

• Endoscopists should consider appendiceal neoplasms, especially with co-existing colonic polyps.
• Adequate time should be dedicated to examining the cecum and appendiceal region during colonoscopy.
• Early detection and management of appendiceal polyps can prevent malignant transformation.