Kinichi Hotta, MD, from the Division of Endoscopy, Shizuoka Cancer Center, in Shizuoka, Japan describes this VideoGIE case “Early cecal cancer adjacent to the appendiceal orifice successfully treated by endoscopic submucosal dissection.”

The cecal tumor adjacent to the appendiceal orifice (CTAO) is considered one of the most difficult lesions to be treated by endoscopic resection. This case was an early cecal T1 cancer which had been successfully treated by endoscopic submucosal dissection (ESD) in en-bloc and R0 resection. Tips of ESD technique unique to this case was that first step mucosal incision was made by only one third at the appendiceal orifice side and submucosal dissection was subsequently done before total circumferential incision. Pathologically this case was diagnosed as a submucosal invasive cancer (invasion depth 240μm from the muscularis mucosae), but there was no other risk factor of metastases. Therefore, this case was considered as curatively treated by ESD.

ESD is very useful for the lesion which is difficult to be treated by conventional endoscopic resection method.

This lesion was diagnosed as a laterally spreading tumor, non-granular type. Moreover, preoperative diagnosis was slightly submucosal invasive cancer by magnified chromoendoscopy.

Treatment strategy of CTAOs should be considered according to location, size, and estimated depth. Precutting EMR is one of the options which was reported in a previous VideoGIE from us (Gastrointest Endosc 2015;82:750).

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