Sessile serrated lesions involving the appendiceal orifice: Endoscopic diagnosis and treatment

Table 1 Comparison of treatment methods for sessile serrated lesions involving the appendiceal orifice

Therapeutic methods	Indications	Advantages	Limitations
EMR/underwater EMR	Lesions limited to the rim of the appendiceal orifice	Minimal invasiveness and ease of performance	Inability to visualize lesions extending into the lumen
ELA	Lesions extending into the lumen and < 15 mm	Preservation of ileocecal region function	Requirement for endoscopist-surgeon collaboration, staged surgery, and multiple bowel preparations
ELA + EMR	Lesions extending into the lumen and > 15 mm
Endoscopic transcecal appendectomy + choledochoscopy	Luminal extension of lesions	Maximized preservation of the ileocecal valve and intestinal tract; accurate identification of the appendix; reduced potential for damage to surrounding tissues; absence of abdominal scars; avoidance of surgical incision-related complications	Future validation of its safety and reliability dependent on additional follow-up data

ELA: Extended laparoscopic appendectomy; EMR: Endoscopic mucosal resection.