TY - JOUR
T1 - Endoscopic Resection of Cecal Polyps Involving the Appendiceal Orifice
T2 - A KASID Multicenter Study
AU - Song, Eun Mi
AU - Yang, Hyo Joon
AU - Lee, Hyun Jung
AU - Lee, Hyun Seok
AU - Cha, Jae Myung
AU - Kim, Hyun Gun
AU - Jung, Yunho
AU - Moon, Chang Mo
AU - Kim, Byung Chang
AU - Byeon, Jeong Sik
N1 - Publisher Copyright:
© 2017, Springer Science+Business Media, LLC.
PY - 2017/11/1
Y1 - 2017/11/1
N2 - Background: Endoscopic resection of polyps located at the appendiceal orifice (AO) is challenging, and the feasibility and outcomes of endoscopic resection for cecal polyps involving AO are unconfirmed. Aims: We evaluated the feasibility and outcomes of endoscopic resection for cecal polyps involving AO. Methods: In this retrospective, multicenter study involving nine tertiary referral centers, we evaluated 131 patients who underwent endoscopic resection for cecal polyps involving AO. Results: The median size of polyps resected was 10 mm (range 3–60 mm). Endoscopic mucosal resection, endoscopic piecemeal mucosal resection, and endoscopic submucosal dissection were performed in 75 (57.3%), 31 (23.7%), and 5 (3.8%) patients, respectively. The en bloc resection rate was 68.7%. Endoscopic complete resection was achieved in 123 lesions (93.9%). Intraprocedural and delayed bleeding occurred in 14 (10.7%) and three patients (2.3%), respectively, and perforation occurred in two patients (1.5%). Seven patients (5.3%) underwent additional surgery because of treatment failure or recurrence. Polyps of ≥20 mm in size showed significantly higher rates of perforation and additional surgery (p < 0.05), and a lower rate of en bloc resection (p < 0.005). Patients with polyps involving ≥75% of AO circumference exhibited a significantly lower rate of en bloc resection (p < 0.001), and significantly higher rates of surgery and recurrence (p < 0.05). Recurrence during follow-up occurred in 12 patients (15.6%); polyps involving ≥75% of AO circumference were an independent risk factor for recurrence. Conclusion: Endoscopic resection of cecal polyps involving AO is safe and effective in select patients.
AB - Background: Endoscopic resection of polyps located at the appendiceal orifice (AO) is challenging, and the feasibility and outcomes of endoscopic resection for cecal polyps involving AO are unconfirmed. Aims: We evaluated the feasibility and outcomes of endoscopic resection for cecal polyps involving AO. Methods: In this retrospective, multicenter study involving nine tertiary referral centers, we evaluated 131 patients who underwent endoscopic resection for cecal polyps involving AO. Results: The median size of polyps resected was 10 mm (range 3–60 mm). Endoscopic mucosal resection, endoscopic piecemeal mucosal resection, and endoscopic submucosal dissection were performed in 75 (57.3%), 31 (23.7%), and 5 (3.8%) patients, respectively. The en bloc resection rate was 68.7%. Endoscopic complete resection was achieved in 123 lesions (93.9%). Intraprocedural and delayed bleeding occurred in 14 (10.7%) and three patients (2.3%), respectively, and perforation occurred in two patients (1.5%). Seven patients (5.3%) underwent additional surgery because of treatment failure or recurrence. Polyps of ≥20 mm in size showed significantly higher rates of perforation and additional surgery (p < 0.05), and a lower rate of en bloc resection (p < 0.005). Patients with polyps involving ≥75% of AO circumference exhibited a significantly lower rate of en bloc resection (p < 0.001), and significantly higher rates of surgery and recurrence (p < 0.05). Recurrence during follow-up occurred in 12 patients (15.6%); polyps involving ≥75% of AO circumference were an independent risk factor for recurrence. Conclusion: Endoscopic resection of cecal polyps involving AO is safe and effective in select patients.
KW - Appendix
KW - Colonic polyps
KW - Colonoscopy
KW - Endoscopic mucosal resection
KW - Endoscopic submucosal dissection
UR - http://www.scopus.com/inward/record.url?scp=85029718156&partnerID=8YFLogxK
U2 - 10.1007/s10620-017-4760-2
DO - 10.1007/s10620-017-4760-2
M3 - Article
C2 - 28936593
AN - SCOPUS:85029718156
SN - 0163-2116
VL - 62
SP - 3138
EP - 3148
JO - Digestive Diseases and Sciences
JF - Digestive Diseases and Sciences
IS - 11
ER -