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Endoscopic transcecal appendectomy for the treatment of low-grade appendiceal mucinous neoplasm
Zhijie Jiang1, Bing Hu2, Hui Gong3
1West China School of Clinical Medicine, Sichuan University, Chengdu, Sichuan Province, China.
Background And Aims:
Appendiceal lesions are a common cause of abdominal pain. The most prevalent pathologic entities are inflammatory lesions, whereas neoplastic lesions are relatively uncommon. Appendiceal mucinous neoplasms (AMNs) are rare neoplastic tumors found in appendectomy specimens. Previously, appendectomy was required for appendiceal lesions. Endoscopic transcecal appendectomy (ETA) is a novel approach that allows the appendiceal lesion to be completely resected and prevents postoperative appendicitis. This case presents ETA as an alternative for management of low-grade AMNs.
Methods:
In this case, ETA was applied to the patient's appendiceal lesion. The ETA procedure involved the following steps: full-thickness resection of the lesion after marking, dissection and cutting off of the mesoappendix and appendicular artery, insertion of a second endoscope for continuous dissection, and closure of the defect.
Results:
The patient was discharged after improvement. Follow-up colonoscopy was performed at 6 months and showed healing of the resection site.
Conclusions:
ETA can serve as a viable alternative for appendiceal lesions unsuitable for polypectomy and as an option to surgical appendectomy. Because ETA can allow maximum preservation of the ileocecal valve and intestine, it leaves no scar on the abdomen and has no adverse event associated with surgical incision.
Insights
Endoscopic transcecal appendectomy (ETA) offers a minimally invasive alternative for resecting appendiceal mucinous neoplasms. This novel approach allows complete lesion removal while preserving the ileocecal valve and preventing postoperative appendicitis.
Area of Science:
- Gastroenterology
- Surgical Innovation
Background:
- Appendiceal lesions, primarily inflammatory, can cause abdominal pain.
- Neoplastic appendiceal lesions, such as appendiceal mucinous neoplasms (AMNs), are uncommon but require management.
- Traditional management for appendiceal lesions involved surgical appendectomy.
Purpose of the Study:
- To present endoscopic transcecal appendectomy (ETA) as a novel, minimally invasive alternative for managing low-grade appendiceal mucinous neoplasms (AMNs).
- To demonstrate the feasibility and efficacy of ETA in completely resecting appendiceal lesions.
Main Methods:
- Endoscopic transcecal appendectomy (ETA) was performed for a patient with an appendiceal lesion.
- The procedure involved full-thickness resection, mesoappendix and appendicular artery dissection, and defect closure.
- A second endoscope was used for continuous dissection during the procedure.
Main Results:
- The patient recovered and was discharged following improvement.
- A 6-month follow-up colonoscopy confirmed successful healing of the resection site without complications.
Conclusions:
- Endoscopic transcecal appendectomy (ETA) is a viable alternative for appendiceal lesions not amenable to polypectomy and for patients who are candidates for surgical appendectomy.
- ETA offers advantages over traditional surgery, including maximum preservation of the ileocecal valve and intestine, no abdominal scarring, and avoidance of surgical incision-related adverse events.
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