Endoscopic Transcecal Appendectomy With a Novel Detachable Over-the-Scope Clip

A 50-year-old woman presented with right lower-abdominal pain for more than 1 month. Colonoscopy revealed a 1.8-cm submucosal bulge near the appendiceal orifice (Figure A). Computed tomography, magnetic resonance imaging, and endoscopic ultrasound were suspicious for appendiceal mucocele. The patient declined laparoscopic or conventional surgical appendectomy, but agreed to endoscopic transcecal appendectomy (ETA) after multidisciplinary discussion. The procedure steps were as follows: the appendiceal lesion margin was marked using a woodpecker I-knife (multifunctional knife, Anrei); a full-thickness circumferential incision was made along the marks and the appendiceal orifice with the woodpecker knife (I- and O-knife); the root of the partially dissected appendix was retracted using a snare to adequately expose the incision line and continue dissection; the woodpecker knife (O-knife) was used to dissect the mesoappendix along the appendix, and mesentery vessels were coagulated with hot biopsy forceps; the appendix and lesion were completely removed with a snare via the anus; and the defect was closed with a novel detachable over-the-scope clip (OTSC) (Senscure) (Figure B) and hemostatic clips. Pathologic assessment confirmed an appendiceal retention mucocele. The patient was discharged 7 days after ETA with no abdominal pain and no complications. The resected area was healing at follow-up colonoscopy after 2 months (Figure C). The OTSC and hemostatic clips were removed during this procedure (Figure D). No delayed complications were noted. ETA is a viable treatment option for patients unable or unwilling to undergo surgery. We report a case of defect closure after ETA using a novel detachable OTSC.