Endoscopic imaging of the vermiform appendix (with video)

BackgroundChronic appendicitis may be detected in as many as 10% of patients with right lower quadrant pain. Although the appendiceal orifice is easily identified during colonoscopy, its lumen has not been investigated so far.ObjectivesTo determine the feasibility of endoscopic appendix imaging to identify features of chronic appendicitis in patients with recurrent right lower quadrant pain.DesignProspective, proof-of-concept study.SettingUniversity-based tertiary referral hospital.PatientsColonoscopy scheduled because of right lower quadrant pain.InterventionsFirst, the appendix orifice was cannulated with a guidewire and a Jagtome. Next fluoroscopic imaging was performed by injection of contrast agent into the appendix orifice, and then a SpyGlass endoscope was inserted for imaging of the appendiceal mucosa and for biopsy. Patients were monitored 3 hours after investigation, with follow-up at 4 weeks.Main Outcome MeasurementsCannulation rate.ResultsThirteen patients were included. Endoscopic imaging of the appendix was successful in 9 of 13 patients (69%). In 10 patients, a guidewire was placed; in 7 patients, biopsy specimens were taken, revealing histological signs of inflammation in 5. In 4 patients, visible fecoliths were removed by flushing. All patients were discharged on the same day. No adverse events occurred. Three patients reported resolution of pain at follow-up. One patient with strictures at appendicoscopy underwent surgical appendectomy. Histology confirmed the findings of chronic appendicitis with fibrosis.LimitationsPatient number limits power for analysis.ConclusionEndoscopic imaging of the appendix is feasible, safe, and clinically useful in patients with suspected chronic appendicitis.