Digital single-operator cholangioscope for endoscopic retrograde appendicitis therapy

Abstract

Background This study aimed to investigate the diagnostic and therapeutic value of a digital single-operator cholangioscope (SOC) system for endoscopic management of acute appendicitis. Methods 14 patients with acute uncomplicated simple or supportive appendicitis were evaluated between November 2018 and September 2020. The diagnosis of acute appendicitis was confirmed by direct colonoscopy imaging and cholangioscope. The success rate of digital SOC-assisted endoscopic retrograde appendicitis therapy (ERAT), the procedure time, postoperative length of hospital stay, complications, and recurrence rate were recorded. Results Technical success rate was 100 %, with high quality imaging of the appendiceal cavity achieved using SOC in all 14 patients. The mean procedure time was 37.8 (standard deviation [SD] 22) minutes. All patients experienced immediate relief from abdominal pain after the procedure. Mean postoperative hospitalization was 1.9 (SD 0.7) days. No recurrence occurred during 2–24 months of follow-up. Conclusion Digital SOC-assisted ERAT provided a feasible, safe, and effective alternative approach for diagnosis and management of acute uncomplicated appendicitis without the need for X-ray or ultrasonic guidance.

Endoscopic retrograde appendicitis therapy for acute appendicitis: a systematic review and meta-analysis

“…Because the shape and size of the appendix varies greatly, it is often challenging to reliably diagnose acute appendicitis with CT and abdominal ultrasound resulting in high negative appendectomy rates. [8,17,19,[26][27][28][29] Several studies have demonstrated that endoscopy combined with appendiceal cavity imaging obtained with ultrasound or X-ray can accurately diagnose acute appendicitis. [10,11,18] [19] The technical success and clinical success of ERAT in our meta-analysis was 99.36% and 99.29% respectively.…”

“…[8,17,19,[26][27][28][29] Several studies have demonstrated that endoscopy combined with appendiceal cavity imaging obtained with ultrasound or X-ray can accurately diagnose acute appendicitis. [10,11,18] [19] The technical success and clinical success of ERAT in our meta-analysis was 99.36% and 99.29% respectively. In a recent study, ERAT was directly compared to antibiotic therapy alone in children with acute uncomplicated appendicitis.…”

“…[10,11,[16][17][18][19] The clinical success was defined as improvement in symptoms such as abdominal pain, nausea and fever. [10,11,[17][18][19][20] Adverse events were related directly to the procedure such as bleeding and perforation.…”

Beyond the end: a cholangioscope in the appendix – a new tool for the management of acute appendicitis?

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As endoscopy fellows, each of us has been taught that the identification of the appendiceal orifice is the goal of colonoscope progression, ensuring examination of the entire colon. In this issue of Endoscopy, Kong et al push the boundaries and propose examination of the appendiceal lumen with a single-operator cholangioscope (SOC) to provide tailored endoscopic retrograde appendicitis therapy (ERAT) [1]. This new application of an SOC is adapted from the fluoroscopic-guided ERAT technique, a minimally invasive treatment first described in 2012 [2].

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Endoscopic full-thickness resection for polyps involving the appendiceal orifice: not yet ready for prime time

“…Endoscopic transcecal appendectomy eliminates lesions both around the orifice and inside the lumen of the appendix, whereas traditional appendectomy is limited to polyps within the lumen of the appendix. Kong et al reported the endoscopic management of appendicitis using a single-operator cholangioscopy system, which allowed detailed examination of the entire appendiceal cavity during colonoscopy [6]. Use of a single-operator cholangioscope or ultrafine endoscope can detect the presence of polyps inside the appendiceal lumen and help to decide the best strategy for management to avoid complications, as well as any extra financial burden on the patients.…”