Periappendiceal polyps present a unique challenge to the endoscopist, as they are often difficult to detect and access in their entirety, frequently extending deep into the appendix. High rates of incomplete resection and procedural risks add to these challenges. Their clinical significance, optimal management strategies and long-term outcomes require further attention. Current management options include surgery, endoscopic mucosal resection (EMR) and newer techniques such as endoscopic full-thickness resection, underwater EMR, endoscopic submucosal dissection and combined endoscopic–laparoscopic resection. This study aims to describe the clinical presentation, management and outcomes of a series of patients with periappendiceal polyps treated in our NHS Trust, with particular emphasis on the multidisciplinary team (MDT) decision-making process and practical considerations for frontline endoscopists. We conducted a retrospective observational study involving 32 patients diagnosed with periappendiceal polyps. Data was collected on demographics, clinical indications for colonoscopy, treatment modalities, histological findings, complications and follow-up outcomes. All cases were discussed in an MDT meeting involving endoscopists, surgeons and radiologists. Polyps were assessed using narrow band imaging (NBI) during colonoscopy to enhance vascular and surface features and assist in the real-time differentiation of hyperplastic polyps, adenomas and sessile serrated lesions (SSLs). NBI International Colorectal Endoscopic classification was routinely applied in line with UK practice. Descriptive statistics were employed for data analysis. The most common indication for colonoscopy was a positive faecal immunochemical test in the National Health Service Bowel Cancer Screening Programme (53.1%). The mean polyp size was 14.1 mm (SD=10.82 mm), with 96.9% of patients having a single periappendiceal polyp. All cases were discussed in an MDT meeting. Endoscopic management was performed in 43.75% of cases, with 12 polyps treated by EMR and 2 by cold snare polypectomy. Surgical management was decided for a few sizeable polyps or those with increased suspicion of malignancy, resulting in appendicectomy for five patients and right hemicolectomy for two. 11 patients were managed conservatively due to associated comorbidities following MDT assessment of fitness for intervention. Histopathological analysis revealed a diverse range of lesions, including 12 SSLs without dysplasia, 6 low-grade tubulovillous adenomas (TVA), 6 low-grade tubular adenomas, 2 hyperplastic polyps and 1 high-grade TVA. Notably, two surgical cases revealed only lymphoid aggregates, highlighting the importance of preresection biopsy to avoid unnecessary surgical intervention, in cases where the endoscopist is not convinced they are dealing with a ‘true’ polyp. Follow-up data was available for 11 patients, with a median site check follow-up of 15 months (range 3 months to 3 years), without signs of endoscopic recurrence in any of these cases. One possible complication reported was appendicitis, which occurred 3 months postpolypectomy. Periappendiceal polyps exhibit histopathological diversity, with SSLs being the most common finding in our series. Although resection can be technically challenging, with appropriate expertise and a collaborative multidisciplinary approach, most lesions can be managed effectively through endoscopic techniques. The MDT approach is crucial for optimising patient selection, avoiding unnecessary interventions and ensuring appropriate follow-up. This case series adds to the currently limited literature on periappendiceal polyps and provides practical insights for their management in routine clinical practice.
Mohamed et al. (Fri,) studied this question.