Post written by Maiko Takita, MD, from the Department of Gastroenterology, NTT Medical Center Tokyo, in Tokyo, Japan

Endoscopic resection for cecal tumors extending to the appendiceal orifice is difficult because the margin cannot be often tracked entirely, in addition to the higher risk of perforation. Here we report a case of a colonic tumor involving the apendiceal orifice successfully treated by endoscopic submucosal dissection (ESD) by reason of the history of appendectomy.

Figure 1. Endoscopic submucosal dissection. A, Large superficial tumor extending to the appendiceal orifice. B-I, The tumor was hollowed from the orifice. J, Resected specimen of tumor. K, Pathologic findings of the specimen (H&E, orig. mag. ×40).

We were able to perform ESD without any adverse event for the patient had undergone an appendectomy in the past. Therefore, his appendiceal orifice had become “shallow.” Consequently, he could avoid the colectomy.

If you could recognize the entire margin of the lesion, there is a possibility that you can resect the lesion endoscopically, even if the lesion has strong fibrosis.