Endoscopy 2020; 52(S 01): S85
DOI: 10.1055/s-0040-1704256
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CLINICAL OUTCOMES OF ENDOSCOPIC SUBMUCOSAL DISSECTION FOR LATERALLY SPREADING TUMORS INVOLVING THE APPENDICEAL ORIfiCE

M Takita
1   NTT Medical Center Tokyo, Gastrointestinal Endoscopy, Tokyo, Japan
,
K Ohata
1   NTT Medical Center Tokyo, Gastrointestinal Endoscopy, Tokyo, Japan
,
M Nobuyuki
2   NTT Medical Center Tokyo, Gastroenterology, Tokyo, Japan
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Publikationsdatum:
23. April 2020 (online)

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    Aims Though colorectal ESD has become standard therapy, the locations which are difficult to treat anatomically are still exist. Lesions involving the appendiceal orifice are known to be difficult to treat. The aim of this study is to evaluate the clinical outcomes of endoscopic treatment for the lesions near the appendiceal orifice.

    Methods A total of 274 consecutive patients with the lesions involving the appendiceal orifice which were endoscopically resected at the NTT Medical Center Tokyo between January 2014 and September 2019 were enrolled. The lesions involving the appendiceal orifice were defined as the lesions within 3mm from the orifice (Group AO). We investigated those clinicopathological findings and treatment outcomes comparing to the lesions located in cecum (Group C).

    Results Of 274 lesions analyzed, 76 were in Group AO and 198 in Group C. The mean diameter was smaller in AO group (29.6±15.1 vs. 34.4±15.5mm, P=0.01). In Group AO, SSA/P was more common (adenoma/SSA/P/cancer=25/32/19 vs. 102/39/57, P< 0.01). All lesions achieved en-broc resection. On the other hand, the rate of complete resection was lower in Group AO (75.0% vs. 92.9%, P< 0.01). Procedure time was longer in Group AO (57.9±34.0 vs. 48.1±39.3min, P=0.03). According to complication, though there were no delayed bleeding, perforation was more frequent in Group AO (9.2% vs. 3.5%, P=0.06). As for the clinical outcomes, both fever

    (35.5% vs. 16.7%, P< 0.01) and abdominal pain (26.3% vs. 10.6%, P< 0.01) were more common in Group AO. As a result, it took longer hospitalization (6.2±0.8 vs. 4.7±1.5d, P< 0.01). However, all cases were managed conservatively.

    Conclusions Though the lesions involving the appendiceal orifice are often smaller than the lesions in cecum, they need longer time to be resected endoscopically and are difficult to achieve complete resection. Moreover, adverse event is more frequent. However, establishment of therapeutic strategy enabled endoscopic resection of them.


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