Background and Aims

EMR of sessile periappendiceal laterally spreading lesions (PA-LSLs) is technically demanding because of poor endoscopic access to the appendiceal lumen and the thin colonic wall at the base of the cecum. We aimed to assess the feasibility and safety of EMR for PA-LSLs.

Methods

Consecutive LSLs ≥20 mm and PA-LSLs ≥10 mm detected at 3 academic endoscopy centers from September 2008 until January 2017 were eligible. Prospective patient, procedural, and lesion data were collected. PA-LSLs were compared with LSLs in other colonic locations.

Results

Thirty-eight PA-LSLs were compared with 1721 LSLs. Referral for surgery without an attempt at EMR was more likely with PA-LSLs (28.9% vs 5.1%, P < .001), and those that involved a greater percentage of the appendiceal orifice (AO) were less likely to be attempted (P = .038). Most PA-LSLs (10/11) were not attempted because of deep extension into the appendiceal lumen; 2 of 11 of these surgical specimens contained invasive cancer. Once attempted, complete clearance of visible adenoma (92.6% PA-LSLs vs 97.6% LSLs, P = .14), adverse events, and rates of adenoma recurrence did not vary significantly between PA-LSLs and LSLs. All 7 patients with prior appendicectomy achieved complete adenoma clearance. There were no cases of post-EMR appendicitis. Twenty of 22 PA-LSLs (91%) eligible for surveillance avoided surgery to longest follow-up.

Conclusions

EMR is a safe, effective, and durable treatment for PA-LSLs when specific criteria are fulfilled. If the distal margin of the PA-LSL within the AO cannot be visualized or if more than 50% of the circumference of the orifice is involved, surgery should be considered. (Clinical trial registration number: NTC01368289.)

中文翻译：

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阑尾孔周围或涉及阑尾孔的侧向扩散病灶的EMR：技术，失败的风险因素以及第三次转诊队列的结果（带视频）

背景和目标

无柄阑尾周围横向扩散性病变（PA-LSLs）的EMR在技术上要求很高，因为内窥镜难以接近阑尾腔和盲肠底部的薄结肠壁。我们旨在评估针对PA-LSL的EMR的可行性和安全性。

方法

从2008年9月至2017年1月在3个学术内窥镜中心检测到的连续LSL≥20 mm和PA-LSL≥10 mm有资格。收集预期的患者，手术和病变数据。将PA-LSL与其他结肠位置的LSL进行了比较。

结果

将38个PA-LSL与1721个LSL进行了比较。PA-LSL更有可能转诊而未进行EMR手术（28.9％vs 5.1％，P  <.001），而那些阑尾孔（AO）占较大百分比的手术则较难尝试（P  = .038）。大多数PA-LSL（10/11）均未尝试，原因是其深入阑尾腔扩展。这些手术标本中的11个中有2个包含浸润性癌症。尝试后，完全清除可见腺瘤（92.6％PA-LSL与97.6％LSL，P = .14），PA-LSL和LSL之间的不良事件和腺瘤复发率没有显着差异。所有7例接受阑尾切除术的患者均实现了完全的腺瘤清除。没有发生EMR后阑尾炎的病例。符合监测条件的22个PA-LSL中有20个（91％）避免了最长的随访手术。

结论

当满足特定标准时，EMR是PA-LSL的安全，有效和持久的治疗方法。如果无法看到AO内PA-LSL的远端边缘，或者涉及孔口周长的50％以上，则应考虑手术。（临床试验注册号：NTC01368289。）