Post written by Hirosato Tamari, MD, from the Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.

A 67-year-old man underwent a positron emission tomography/computed tomography (PET/CT) scan for thyroid cancer and was found to have an accumulation in the cecum (SUVmax value: 8.1) and in the thyroid gland. Colonoscopy revealed a pedunculated appendiceal polyp. The polyp was diagnosed as a non-neoplasia with narrow-band imaging. The stalk of the polyp was buried inside the appendix, and even with the traction through the transparent hood only the stalk was managed to be seen. To get the whole appearance, we used the S-O clip. The S-O clip consists of a spring (5-mm long and 1.8-mm wide), with an attached metal clip at one end and a nylon loop at the other. The S-O clip was placed on the top of the polyp, and the nylon loop of the S-O clip was hooked by the normal clip and fixed at the opposite side of the polyp at a distance of 2 folds behind the scope tip. The extension of the spring provided appropriate traction, and the polyp was lifted. The base of the stalk, which had been buried inside the appendix, was clearly visible. Endoscopic resection was performed while looking at the entire polyp.

In appendiceal lesions, endoscopic treatment is often challenging because it is difficult to see the whole appearance and gain access into the appendix. The S-O clip is useful as one of the methods to safely perform endoscopic resection of appendiceal lesions. We think that this will contribute to the development of endoscopic treatment.

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