Evaluation of Subepithelial Abnormalities of the Appendix by Endoscopic Ultrasound

Abstract

Background. The use of through-the-scope (TTS) miniprobe catheter endoscopic ultrasound is a valuable technique for evaluating subepithelial lesions in the proximal colon. Few reports include the evaluation of the appendix by EUS. Objective. To describe endoscopic and endosonographic characteristics of subepithelial lesions of the appendix. Methods. Retrospective case series in a single academic medical center. Adult patients referred for evaluation of subepithelial lesions of the appendix identified by colonoscopy between April 1, 2003 to February 29, 2008. Data were abstracted from an electronic endoscopic database for all patients undergoing miniprobe endoscopic ultrasound examination of the appendix. Medical records were reviewed for patient followup and outcomes. Results. Nine cases were identified. Seven (78%) patients were female. Seven (78%) utilized the 12 MHz miniprobe device and two (22%) used the 20 MHz device. Three mucoceles were described and confirmed by surgical resection. Cases also included one inverted appendix, one gastrointestinal stromal tumor, and one lipoma. In three cases, no abnormality was found. Conclusions. EUS evaluation of the appendix is feasible with standard miniprobe devices and may assist in the selection of patients who may benefit from surgical management.

Management Options of Giant Colonic Lipomas

“…However, when symptoms develop, they are generally associated with lipomas greater than 2 cm in diameter, with giant lipomas posing the greatest risk for complications. Despite the relative rarity and mostly asymptomatic nature of colonic lipomas, their proper identification and diagnosis are vital to ensure correct management, as they can resemble gastrointestinal stromal tumors [ 12 ], harbor premalignant lesions (tubulovillous adenomas) [ 13 ], or assist in identifying genetic syndromes (Cowden) [ 14 ]. Although lipomas retain no malignant potential, at times, they can be difficult to discern from liposarcomas or other malignant lesions, especially in the setting of intussusception [ 5 , 9 ].…”

Miniprobe Endoscopic Sonography for Gastrointestinal Tract Assessment: A Case Series of 1451 Procedures

“…Major indications for miniprobe endoscopic sonography include digestive cancer staging and assessment of subepithelial lesions, including subepithelial abnormalities of the appendix . Shimoyama et al studied the staging of esophageal cancer using 12‐ to 20‐MHz miniprobes for tumor staging and differentiated correctly T1 cancers in 86% of cases, and Chemaly et al obtained accuracy with miniprobe endoscopic sonography of 73.5% for differentiating T1sm from T1m tumors .…”

Two Cases of Appendiceal Intussusception: A Rare Diagnostic Pitfall in Colonoscopy

“…It is therefore advisable to perform gross examination of all caecal polyps after colonoscopic removal. A recent advance is the use of through-the-scope miniprobe catheter endoscopic ultrasound to evaluate abnormal findings of the appendix identified by colonoscopy and allow selection of those in need of surgical management [ 5 ]. Preligation with Endoloop and postpolypectomy ligation technique using the Anchor clip may minimize the risk of postpolypectomy hemorrhage [ 8 – 10 ].…”