Sessile serrated lesions involving the appendiceal orifice: Endoscopic diagnosis and treatment

Some studies have reported that approximately 50% of appendiceal lesions are sessile serrated lesions (SSLs). Traditionally, surgical intervention has been the preferred method. Endoscopic procedures such as endoscopic mucosal resection (EMR) serve as alternative treatments for lesions at the appendiceal orifice (AO). However, EMR is not appropriate when the lesion margin within the AO cannot be visualized. When lesions extend into the lumen, extended laparoscopic appendectomy (ELA) or combined surgery can be used to resect the lesions. Compared with traditional surgery and EMR, ELA or combined surgery is a safer and more precise option that preserves the function of the ileocecal region. However, the need for coordination between surgeons and endoscopists, along with the requirement for staged procedures and multiple bowel preparations, increases the complexity of the treatment. In recent years, with the advancement of endoscopic full-thickness resection, endoscopic transcecal appendectomy (ETA) has been used to treat SSLs involving the AO. The use of choledochoscopy in conjunction with ETA can further enhance treatment precision. This integrated approach holds promise for replacing the combined endoscopic and laparoscopic surgical techniques. However, additional data are required to confirm its safety and efficacy.