Endoscopic Resection of Cecal Neoplasia With Full-thickness Resection of the Appendiceal Stump Using Double-layered Suturing

A 73-year-old woman with a history of appendectomy for acute appendicitis was diagnosed with a 20-mm laterally spreading tumor involving the appendiceal orifice site (Figure A). Although computed tomography scan revealed the whole image of the appendiceal stump, the tumor margin could not be confirmed endoscopically. Complete resection of the tumor using conventional endoscopic submucosal dissection procedure was difficult, and endoscopic excision, including full-thickness resection of the appendiceal stump, was performed. After a circumferential mucosal incision, a multiloop traction device (Boston Scientific Co) was applied, and the severely fibrotic submucosal layer was visualized. As submucosal dissection proceeded, a hollow appeared at the depression site of appendiceal stump (Figure B). Successful en bloc resection was achieved, and a defect in the muscle layer was confirmed (Figure C). The post-resection ulcer, including the muscular defect, was robustly closed using the double-layered suturing method (Figure D). The patient was discharged 5 days postoperatively without any adverse events. Histological examination revealed an 18-mm serrated lesion with negative resection margins. The development of traction devices and recent advancements in novel closure techniques can lead to further expansion of indications for endoscopic resection with the clinical benefit of avoiding invasive surgery. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI0NDgxOTY5YzUxMjkyMmMwYjA0MmFlZmRmNDg2ZWJmZCIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNzE1MTAwNTY2fQ.N4LGwC9zQopypRl9LtQqex41va7cjmz6_aBhGCHT4WymKb7tiMbvOVo99NPtEOClY7IeE6BZlLZgcdzS1UFk7ieBCslpk1fxFEzPuTEmTkkC-C50Zo9LJc69-t7se1YQm5ST_XwEEY1aQJphJ_VrY1o3VkHac8nu_zTUoBlyUPWWvXTmL7qLlXgP1Hnq7RgiH4RiFru53pE1LcgF_DrGWLDyubR6Ug37wNBSA-kK-cR_XUbFC-kUE7vJcNSq08GyOPyoLEHfKDuhheqXde462h5FRlRoQpqJf9kk4zvn06zXbEs5RtyoHx-AEXYc5J75w62khx0gdVyIrQiVhshmkw Download .mp4 (50.59 MB) Help with .mp4 files Video