Juan Castano, MD1, Grigoriy Rapoport, MD2, Arturo Suplee Rivera, MD3, Muhammed Nathani, MD, FACG4, Asif Zamir, MD5
1University of Texas Rio Grande Valley at Doctors Hospital at Renaissance, Edinburg, TX; 2University of Texas Health Rio Grande Valley, Edinburg, TX; 3University of Texas Rio Grande Valley, McAllen, TX; 4Kelsey-Seybold Clinic, Houston, TX; 5Doctors Hospital at Renaissance, Edinburg, TX
Introduction: Appendiceal orifice (AO) polyps are uncommon. They are usually removed surgically due to technical difficulties and high risk of perforation with endoscopic intervention. In the following case we present a patient with a 6 cm AO polyp removed successfully with snare cautery technique during colonoscopy.
Case Description/Methods: A 66-year-old man presented to our clinic for colorectal cancer screening. During colonoscopy, careful inspection of the AO revealed a subtle bulge. A submucosal injection of the AO using Eleview revealed a 6cm cauliflower-like lesion. The AO polyp was then removed with snare cautery polypectomy technique without any complications. The edges were approximated with endoscopic mechanical clips. Biopsy results showed tubular adenoma without dysplasia.
Discussion: The majority of AO polyps are removed surgically due to potential complications, especially perforation. Currently, there are no guidelines that discuss management of these polyps due to lack of available data. A retrospective study involving 131 patients from multiple tertiary centers showed that polyps more than 20 mm in size undergoing endoscopic resection had significantly higher rates of perforation. Another retrospective study of 691 patients found that AO polyps greater than 5 mm in size were more likely to require surgery. Additionally, it has been reported that AO polyps encompassing more than 75% circumference have low resection rates.
To our knowledge, this case is one of the largest endoscopic removal of an AO polyp encompassing the majority of the AO circumference without complications. Although traditionally AO polyps are removed surgically, our case suggests an alternative, less invasive and effective method of removing these difficult polyps. In order to validate our claim, documentation of more cases would be required.
Citation: Juan Castano, MD; Grigoriy Rapoport, MD; Arturo Suplee Rivera, MD; Muhammed Nathani, MD, FACG; Asif Zamir, MD. P2010 - REMOVAL OF A 6CM APPENDICEAL ORIFICE POLYP WITH SNARE CAUTERY POLYPECTOMY. Program No. P2010. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.