A Practical Endoscopic Treatment Strategy for Appendiceal Orifice Lesions Using Forceps-Assisted Polypectomy (Strip...

Endoscopic treatment of small lesions involving the appendiceal orifice remains technically challenging. Although endoscopic submucosal dissection (ESD) enables en bloc resection, it may represent overtreatment for such lesions. In contrast, forceps-assisted polypectomy; strip biopsy may serve as an effective therapeutic option. The aim of this study was to propose a practical, real-world treatment strategy and to evaluate the clinical usefulness of strip biopsy.

This retrospective single-center study included patients who underwent endoscopic treatment for appendiceal orifice lesions between May 2017 and September 2025. Patients were classified into strip biopsy or ESD group. Procedural outcomes and adverse events were compared.

Twenty-two appendiceal orifice lesions were included, with 14 treated by strip biopsy and 8 by ESD. Baseline characteristics were comparable. Procedure time was significantly shorter in the strip biopsy group (6.6 ± 2.9 vs. 45.9 ± 31.3 min, p < 0.05). En bloc resection rates were 93 and 100%, respectively. No perforation occurred, and delayed bleeding was observed in one ESD case only. Positive or unclear horizontal margins were more frequent in the strip biopsy group than in the ESD group (50 vs. 13%, p = 0.16). Among patients who completed 1-year surveillance colonoscopy, no local recurrence was observed.

Strip biopsy may be a feasible and rapid treatment option for carefully selected small appendiceal orifice lesions without endoscopic features suggestive of malignancy. However, because of the retrospective design, small sample size, and limited follow-up data, further prospective studies with larger cohorts and longer follow-up are warranted.