Meta-Analysis of Appendicitis Risk With Endoscopic Full-Thickness Resection of Appendiceal Orifice Lesions
Douglas K. Rex, MD, MASGE, reviewing Obri M, et al. Endosc Int Open 2023 Jul 17.
There is agreement that endoscopic full-thickness resection (EFTR) is a great procedure for lesions extending into the appendiceal orifice (AO) when there has been a previous appendectomy. Absent of prior appendectomy, patients undergoing EFTR of lesions at the AO have a risk of developing appendicitis.
This systematic review and meta-analysis identified 14 relevant studies of EFTR of AO lesions using a full-thickness resection device and evaluated patients for appendicitis risk after the procedure. Among 203 patients with no prior appendectomy, the overall rate of appendicitis after EFTR was 15%, with a 61% rate of patients requiring appendectomy (overall, the need for surgical intervention for appendicitis after EFTR was 11%).
Technical success was 92% in complete resection and 98% with histologic full-thickness resection. Histologic R0 resection was achieved in 72% of patients.
COMMENTThis report may be the best current update on appendicitis risk after EFTR of AO lesions. The 72% R0 resection rate adds another limitation to EFTR of AO lesions with intact appendix.
It’s not clear from the report whether lower R0 resection resulted primarily from unresected disease in the cecum (which might be overcome by endoscopically resecting parts of the lesion prior to EFTR) or sometimes by extension of the lesion down the appendiceal lumen to a point beyond the reach of the full-thickness resection.
Laparoscopic resection of the distal cecum (if benign, these lesions do not require right hemicolectomy) is a simple surgical treatment for benign lesions extending into the AO with an intact appendix. Given the appendicitis risk and the R0 resection rate of only 72%, surgical resection of the distal cecum and appendix still competes with EFTR for AO lesions with the appendix in place.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Obri M, Ichkhanian Y, Brown P, et al. Full thickness resection device for the management of lesions involving the appendiceal orifice: systematic review and meta-analysis. Endosc Int Open 2023 Jul 17. (Epub ahead of print) (https://doi.org/10.1055/a-2131-4891)
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