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CC BY 4.0 · Endoscopy 2025; 57(S 01): E617-E618
DOI: 10.1055/a-2602-3154
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Endoscopic direct-vision appendicitis therapy for the treatment of chronic appendicitis with multiple appendicoliths

Authors

  • Li-Hua Ren 

    1   Department of Gastroenterology, Zhongda Hospital, Southeast University, Nanjing, China

  • Yuan Ding

    2   School of Medicine, Southeast University, Nanjing, China (Ringgold ID: RIN12579)

  • Yuanyuan Li

    1   Department of Gastroenterology, Zhongda Hospital, Southeast University, Nanjing, China
    3   School of Public Health, Soochow University, Suzhou, China (Ringgold ID: RIN572403)

  • Yadong Feng 

    1   Department of Gastroenterology, Zhongda Hospital, Southeast University, Nanjing, China

  • Lin Yang

    1   Department of Gastroenterology, Zhongda Hospital, Southeast University, Nanjing, China
    4   Nanjing Medical University, Nanjing, China (Ringgold ID: RIN12461)

  • Yuan-Yuan Han

    1   Department of Gastroenterology, Zhongda Hospital, Southeast University, Nanjing, China

  • Rui-Hua Shi

    1   Department of Gastroenterology, Zhongda Hospital, Southeast University, Nanjing, China

Supported by: China Postdoctoral Science Foundation 2023M730587
Supported by: Research talents training program of Zhongda Hospital affiliated to Southeast University CZXM-GSP-RC17
Supported by: Jiangsu Provincial Basic Research Special Fund (Natural Science Foundation) Youth Fund BK20241683
Supported by: National Natural Science Foundation of China 82404088
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Appendicoliths are considered as a well-established etiology factor in both acute appendicitis and chronic abdominal pain syndromes [1]. While appendectomy remains definitive for acute appendicitis, emerging endoscopic strategies, especially natural orifice transluminal endoscopic surgery (NOTES) illuminate organ-preserving alternatives, particularly in complex cases where conventional approaches falter [2]. Endoscopic retrograde appendicitis therapy (ERAT) is increasingly utilized in acute appendicitis therapy [3] [4]. However, it technically depends on fluoroscopic guidance and carries risks of perforation during blind cannulation of the appendiceal lumen with contrast catheters [5]. Herein we present a case of multiple large appendicoliths with chronic obstruction successfully resolved through endoscopic direct-vision appendicitis therapy (EDAT) ([Video 1]).

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EDAT for the management of multiple appendicoliths with chronic pain in a 28-year-old man. Abbreviation: EDAT, endoscopic direct-vision appendicitis therapy.Video 1

A 28-year-old man presenting with a 1-year history of intermittent right lower quadrant dull pain, acutely exacerbated in the preceding week was admitted to our medical team. Contrast-enhanced computed tomography (CT) revealed four calculi within the appendiceal lumen with the largest measuring 1.4 cm in maximal diameter ([Fig. 1] a–c). The patient declined surgical intervention and had undergone conservative medical treatment with limited efficacy. We performed EDAT ([Fig. 2] a–i), which enabled complete appendicolith extraction and resulted in immediate resolution of abdominal pain. Intravenous antibiotics were administered for 24 hours, and a semi-liquid diet was initiated on postoperative day 2 (POD 2). The patient was discharged on POD 3 without recurrence of symptoms.

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Fig. 1 CT imagings prior to EDAT. a A calcified stone with a maximum axial diameter of 14.82 mm. b Another stone exhibiting a maximal longitudinal dimension of 12.23 mm. c Coronal reconstruction revealing clustered appendicoliths. Abbreviations: CT, computed tomography; EDAT, endoscopic direct-vision appendicitis therapy.
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Fig. 2 EDAT for the appendicolith management. a A colonoscope was advanced to the ileocecal region, and identified the appendiceal orifice. b A choledochoscope was accessed through the biopsy channel and angled leftward and upward into the appendiceal lumen under direct visualization. c Multiple appendicoliths were visualized in the proximal lumen. d A spiral stone extraction basket was entrapped due to luminal stenosis and stone adhesion. e A controlled radial expansion balloon was deployed over a guidewire to dilate the stenotic segment. f The entrapped basket was disengaged following the appendiceal orifice dilation. g Subsequent calculi extraction was performed using a balloon-anchored traction. h Multiple stones were extracted into the colonic lumen. i Post-procedural choledochoscopic evaluation confirmed complete clearance without mucosal injury. Abbreviation: EDAT, endoscopic direct-vision appendicitis therapy.

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Publication History

Article published online:
18 June 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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