P1062 - The Efficacy and Safety of Endoscopic Submucosal Dissection in Peri-Appendiceal Lesions: A Systematic Review and Meta-Analysis

Hazem Abosheaishaa, MD¹, Abdellatif Ismail, MD², Mohanad Awadalla, MD³, Shaikhoon Mohammed, MD⁴, Monzer Abdalla, MD⁵, Ayman Elawad, MD⁶, Chukwunonso Ezeani, MBBS⁷, Jenson Phung, MD⁸, Mohamed Abdallah, MD⁹, Neil Nero, ⁹, Amit Bhatt, MD¹⁰, Madhusudhan R. Sanaka, MD¹¹, Mohammad Bilal, MD^12
1Icahn School of Medicine at Mount Sinai, Queens, NY; ²University of Maryland Medical Center, Baltimore, MD; ³Beth Israel Deaconess Medical Center, Boston, MA; ⁴Macon Medical Group PC, Atlanta, GA; ⁵Ascension Saint Francis Hospital, Evanston, IL; ⁶Massachusetts General Hospital, Boston, MA; ⁷Baton Rouge General Medical Center, Baton Rouge, LA; ⁸University of Minnesota, Minneapolis, MN; ⁹Cleveland Clinic, Cleveland, OH; ¹⁰Digestive Disease Institute, Cleveland Clinic, Cleveland, OH; ¹¹Cleveland Clinic Foundation, Cleveland, OH; ¹²University of Minnesota and Minneapolis VA Health Care System, Minneapolis, MN

Introduction: Endoscopic submucosal dissection (ESD) has emerged as a promising technique for managing early-stage gastrointestinal neoplastic lesions. However, its application to peri-appendiceal lesions presents unique challenges due to anatomical complexities and the theoretical risk of causing appendicitis or bowel perforation associated with endoscopic resections. Therefore, surgical resection is often used to manage these lesions. This systematic review and meta-analysis aim to evaluate the safety and efficacy of ESD in managing peri-appendiceal lesions.

Methods: A systematic search across multiple databases was conducted, adhering to PRISMA guidelines. Eligible studies focused on adult populations undergoing ESD for peri-appendiceal lesions. The primary outcome was technical success and secondary outcomes included R0 resection, en-bloc resection, adverse events (AEs), and the need for surgery. Data was reported using confidence interval (CI) and heterogeneity (I²).

Results: Six studies comprising 298 patients were included. Technical success was achieved in 98% [95% CI [97 -100 %]; I:4.63%], with R0 resection and en-bloc resection rates of 84% [95% CI [77%-91%]; I:61.86%] and 92%, [95% CI [86%-97%]; I:66.11%], respectively. The overall rates of polyp recurrence, appendicitis, and bleeding were 0.1% [95% CI [0%-2%]; I :0 %], 3% [95% CI [0%-4%]; I :0 %], and 1% [95% CI [0%-3%]; I :0 %], respectively with, and respectively. The incidence of perforation was 11% [95% CI [3%-19%]; I:84.55%], and the need for surgical intervention was 6% [95% CI [1%-10%]; I:74.12%].

Discussion: Our study showed that ESD is an effective alternative to surgical resection for managing periappendiceal lesions. The high rates of technical success (98%), en-bloc resection (92%), and R0 resection (84%) indicate that ESD can achieve thorough and precise removal of these lesions. However, the relatively high incidence of perforation (11%) and the need for surgical intervention in some cases (6%) highlight the necessity for careful patient selection and skilled execution of the procedure.



Disclosures:


Hazem Abosheaishaa, MD¹, Abdellatif Ismail, MD², Mohanad Awadalla, MD³, Shaikhoon Mohammed, MD⁴, Monzer Abdalla, MD⁵, Ayman Elawad, MD⁶, Chukwunonso Ezeani, MBBS⁷, Jenson Phung, MD⁸, Mohamed Abdallah, MD⁹, Neil Nero, ⁹, Amit Bhatt, MD¹⁰, Madhusudhan R. Sanaka, MD¹¹, Mohammad Bilal, MD¹². P1062 - The Efficacy and Safety of Endoscopic Submucosal Dissection in Peri-Appendiceal Lesions: A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.