Therapeutic endoscopy and appendiceal lesions – train and evaluate before intervening

Abstract

We read with great interest the study by Uchima et al. on cap-suction underwater endoscopic mucosal resection (CAP-UEMR) of appendiceal lesions [1]. The authors concluded that CAP-UEMR is safe and effective for lesions involving the appendiceal orifice or ileocecal valve. Notably, seven patients had intraprocedural bleeding requiring endoscopic intervention, two had delayed bleeding, and one patient had recurrence within the short follow-up duration of the study (median 197 days). CAP-UEMR at the appendiceal orifice is technically challenging and has two notable issues. First, incomplete resection may become a major deterrent if the extent of appendiceal involvement is not confirmed prior to the procedure.