Post written by Fatih Aslan, MD, from Koc University Hospital, Istanbul, Turkey.

In this case, we performed an endoscopic treatment for a laterally spreading lesion involving the lumen of the appendix with poorly defined borders. The procedure included endoscopic submucosal dissection combined with transcecal endoscopic appendectomy. Hand suturing was used for traction and separate closure of the muscular and mucosal layers with barbed sutures. The entire procedure was completed without adverse events, and curative resection was achieved.

Lesions involving the appendiceal orifice and lumen pose significant challenges because of anatomical complexity and indistinct margins. Traditional surgical approaches carry a risk of morbidity. Developing a safe, minimally invasive endoscopic alternative is of high clinical importance. This case demonstrates a novel approach where hand suturing facilitated effective traction and secure closure, potentially redefining endoscopic management strategies for such lesions.

This case shows that barbed sutures can be effectively used not only for closure, but also for traction of the lesion and appendix during dissection. This technique enhances dissection speed, reduces the risk of adverse events, and enables curative resection without the need for surgery. Furthermore, using a double-layer closure (muscular and mucosal) minimizes the risks of delayed perforation and air leakage after the procedure.

Adapting barbed sutures, commonly used in surgery, into advanced endoscopic practice opens a new minimally invasive treatment horizon, particularly in anatomically challenging areas such as the appendix. This case encourages broader application of endoscopic techniques for appendiceal lesions previously considered difficult to manage endoscopically.

View of the appendix under traction and the application of muscular sutures.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.