Endoscopic transcecal appendectomy for the treatment of low-grade appendiceal mucinous neoplasm.

Background and Aims: Appendiceal lesions are a common cause of abdominal pain. The most prevalent pathologic entities are inflammatory lesions, whereas neoplastic lesions are relatively uncommon. Appendiceal mucinous neoplasms (AMNs) are rare neoplastic tumors found in appendectomy specimens. Previously, appendectomy was required for appendiceal lesions. Endoscopic transcecal appendectomy (ETA) is a novel approach that allows the appendiceal lesion to be completely resected and prevents postoperative appendicitis. This case presents ETA as an alternative for management of low-grade AMNs. Methods: In this case, ETA was applied to the patient's appendiceal lesion. The ETA procedure involved the following steps: full-thickness resection of the lesion after marking, dissection and cutting off of the mesoappendix and appendicular artery, insertion of a second endoscope for continuous dissection, and closure of the defect. Results: The patient was discharged after improvement. Follow-up colonoscopy was performed at 6 months and showed healing of the resection site. Conclusions: ETA can serve as a viable alternative for appendiceal lesions unsuitable for polypectomy and as an option to surgical appendectomy. Because ETA can allow maximum preservation of the ileocecal valve and intestine, it leaves no scar on the abdomen and has no adverse event associated with surgical incision.