CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(09): E899-E907
DOI: 10.1055/a-2131-4891
Original article

Full-thickness resection device for management of lesions involving the appendiceal orifice: Systematic review and meta-analysis

1   Internal Medicine, Henry Ford Health System, Detroit, United States (Ringgold ID: RIN2971)
,
Yervant Ichkhanian
1   Internal Medicine, Henry Ford Health System, Detroit, United States (Ringgold ID: RIN2971)
,
Patrick Brown
2   Division of Gastroenterology, Henry Ford Health System, Detroit, United States (Ringgold ID: RIN2971)
,
Mohamed Ramzi Almajed
1   Internal Medicine, Henry Ford Health System, Detroit, United States (Ringgold ID: RIN2971)
,
Faisal Nimri
2   Division of Gastroenterology, Henry Ford Health System, Detroit, United States (Ringgold ID: RIN2971)
,
Ashraf Taha
2   Division of Gastroenterology, Henry Ford Health System, Detroit, United States (Ringgold ID: RIN2971)
,
Yasmine Agha
2   Division of Gastroenterology, Henry Ford Health System, Detroit, United States (Ringgold ID: RIN2971)
,
Michelle Jesse
1   Internal Medicine, Henry Ford Health System, Detroit, United States (Ringgold ID: RIN2971)
,
Sumit Singla
3   Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, United States (Ringgold ID: RIN24016)
,
Cyrus Piraka
3   Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, United States (Ringgold ID: RIN24016)
,
Tobias E. Zuchelli
3   Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, United States (Ringgold ID: RIN24016)
› Author Affiliations

Abstract

Background and study aims Endoscopic resection of lesions involving the appendiceal orifice is technically challenging and is commonly referred for surgical resection. However, post-resection appendicitis is a concern. Many studies have varying rates of post-procedure appendicitis. We aim to report the rate of post-resection appendicitis by performing a systematic review and meta-analysis.

Methods Studies that involved the use of a full-thickness resection device (FTRD) for management of appendiceal polyps were included. The primary outcome was appendicitis after FTRD and a subgroup analysis was performed on studies that only included FTRD performed at the appendiceal orifice.

Results Appendicitis was encountered in 15% (95%CI: [11–21]) of the patients with 61% (95% CI: [44–76]) requiring surgical management. Pooled rates of technical success, histologic FTR, and histologic R0 resection in this sub-group (n=123) were 92% (95% CI: [85–96]), 98% (95% CI: [93–100]), and 72% (95% CI: [64–84%]), respectively. Post-resection histopathological evaluation revealed a mean resected specimen size of 16.8 ± 5.4 mm, with non-neoplastic pathology in 9 (7%), adenomas in 103 (84%), adenomas + high-grade dysplasia (HGD) in nine (7%), and adenocarcinoma in two (2%). The pooled rate for non-appendicitis-related surgical management (technical failure and/or high-risk lesions) was 11 % (CI: 7–17).

Conclusions FTRD appears to be an effective method for managing appendiceal lesions. However, appendicitis post-resection occurs in a non-trivial number of patients and the R0 resection rate in appendiceal lesions is only 72%. Therefore, caution should be employed in the use of this technique, considering the relative risks of surgical intervention in each patient.



Publication History

Received: 29 January 2023

Accepted after revision: 11 July 2023

Accepted Manuscript online:
17 July 2023

Article published online:
06 October 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany