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Endoscopic Resection of Cecal Polyps Involving the Appendiceal Orifice: A KASID Multicenter Study

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Abstract

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.

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Author notes

  1. Eun Mi Song and Hyo-Joon Yang have contributed equally to this paper.

Authors and Affiliations

  1. Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

    Eun Mi Song & Jeong-Sik Byeon

  2. Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

    Hyo-Joon Yang

  3. Division of Gastroenterology and Institute of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea

    Hyun Jung Lee

  4. Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea

    Hyun Seok Lee

  5. Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, Korea

    Jae Myung Cha

  6. Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea

    Hyun Gun Kim

  7. Division of Gastroenterology, Department of Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea

    Yunho Jung

  8. Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea

    Chang Mo Moon

  9. Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea

    Byung Chang Kim

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  1. Eun Mi Song
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Correspondence to Jeong-Sik Byeon.

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The authors have no conflict of interest or financial ties to disclose.

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Song, E.M., Yang, HJ., Lee, H.J. et al. Endoscopic Resection of Cecal Polyps Involving the Appendiceal Orifice: A KASID Multicenter Study. Dig Dis Sci 62, 3138–3148 (2017). https://doi.org/10.1007/s10620-017-4760-2

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  • DOI: https://doi.org/10.1007/s10620-017-4760-2

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