Traction device to remove an adenoma in the appendiceal orifice by endoscopic submucosal dissection

Underwater EMR of adenomas of the appendiceal orifice (with video)

“…We found suctioning of water to enable a gradual, controlled retraction of the AO into the open snare (Video 1). These maneuvers obviated the need for manual traction, as has been described in case reports [7,8]. We were able to remove 59% of adenomas in an en bloc fashion, with a mean size of 14 mm.…”

“…There was no perforation, bleeding requiring transfusion, or appendicitis. Final histology was tubular adenoma (7), tubulovillous adenoma (4), sessile serrated adenoma (15), and invasive adenocarcinoma (1). Twenty of 23 patients (87%), not referred to surgery, had follow-up colonoscopy with biopsies of the resection site after a median of 28 weeks (range: 12-139) after resection.…”

Endoscopic submucosal dissection with a hand‐made traction method for a tumor completely covering the post‐appendectomy orifice

“…The efficacy of the traction method for colorectal ESD has been reported, and this method is suitable for tumors located at the appendiceal orifice, because of the thin luminal wall and higher risk of fibrosis. Usually, tumors completely covering the appendiceal orifice cannot be resected endoscopically, and surgery is required.…”

Underwater endoscopic submucosal dissection of a nonpolypoid superficial tumor spreading into the appendix

“… Coumaros et al 8 1 15 EMR 0/0 n.a. Binmoeller et al 3 22 15 (8-50) ∗ Uw-EMR 19 (86)/0 7 mo: 10% ∗ /0 Takeda et al 10 1 7 ESD 1/0 n.a. Jacob et al 2 9 36 (10-110) ∗ ESD 8 (89)/0 24 mo: 0/1 (11) Present case 1 20 Uw-ESD 1/0 12 mo: 0/0 AA , Acute appendicitis; ER , endoscopic resection; ESD , endoscopic submucosal dissection; mo , months; n.a.…”

“…Appendiceal ESD seems feasible, and manipulation of knives very close to the tumor may guarantee higher rates of en bloc and complete resection, but endoscopists should be familiar with submucosal fibrosis and counter traction methods. 10 …”