Zhang MY, Yao JJ, Pan SX, Hou WW, Wei X, Zhao XL, Fu JD. Sessile serrated lesions involving the appendiceal orifice: Endoscopic diagnosis and treatment. World J Gastrointest Endosc 2025; 17(10): 110417 [DOI: 10.4253/wjge.v17.i10.110417]
Corresponding Author of This Article
Jin-Dong Fu, Chief Physician, Department of Gastroenterology, The People’s Hospital of Rizhao, No. 126 Taian Road, Rizhao 276800, Shandong Province, China. 36943087@qq.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Meng-Yuan Zhang, Jing-Jing Yao, Sheng-Xue Pan, Wen-Wen Hou, Xin Wei, Xiang-Lu Zhao, Jin-Dong Fu, Department of Gastroenterology, The People’s Hospital of Rizhao, Rizhao 276800, Shandong Province, China
Author contributions: Zhang MY performed the majority of the writing; Yao JJ and Fu JD prepared the figures and tables; Pan SX, Hou WW, Wei X, and Zhao XL contributed to the writing of the manuscript; All authors read and approved the final version of the manuscript to be published.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jin-Dong Fu, Chief Physician, Department of Gastroenterology, The People’s Hospital of Rizhao, No. 126 Taian Road, Rizhao 276800, Shandong Province, China. 36943087@qq.com
Received: June 6, 2025 Revised: June 25, 2025 Accepted: September 17, 2025 Published online: October 16, 2025 Processing time: 132 Days and 17.3 Hours
Abstract
Some studies have reported that approximately 50% of appendiceal lesions are sessile serrated lesions (SSLs). Traditionally, surgical intervention has been the preferred method. Endoscopic procedures such as endoscopic mucosal resection (EMR) serve as alternative treatments for lesions at the appendiceal orifice (AO). However, EMR is not appropriate when the lesion margin within the AO cannot be visualized. When lesions extend into the lumen, extended laparoscopic appendectomy (ELA) or combined surgery can be used to resect the lesions. Compared with traditional surgery and EMR, ELA or combined surgery is a safer and more precise option that preserves the function of the ileocecal region. However, the need for coordination between surgeons and endoscopists, along with the requirement for staged procedures and multiple bowel preparations, increases the complexity of the treatment. In recent years, with the advancement of endoscopic full-thickness resection, endoscopic transcecal appendectomy (ETA) has been used to treat SSLs involving the AO. The use of choledochoscopy in conjunction with ETA can further enhance treatment precision. This integrated approach holds promise for replacing the combined endoscopic and laparoscopic surgical techniques. However, additional data are required to confirm its safety and efficacy.
Core Tip: The application of endoscopic full-thickness resection has enabled the feasibility of endoscopic appendectomy. When combined with choledochoscopy, it further enhances the accuracy of the procedure. This integrated approach offers a novel therapeutic strategy for sessile serrated lesions involving the appendix, potentially replacing the combination of endoscopy and laparoscopy. Future validation of its safety and reliability will depend on additional follow-up data.
