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Endoscopy
Endoscopy
10.1055/s-00000012
Endoscopy
Endoscopy
0013-726X
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Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

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10.1055/a-2410-3702
E-Videos-2024-06-5154-EV
E-Videos
Digital single-operator cholangioscope-assisted endoscopic retrograde appendicitis therapy in the management of Crohnʼs disease with acute appendicitis
Lin Dezheng
Su Mingli Dr.
Su Yuping
Guo Zehui
Deng Jiaxin Dr.
Chen Yongcheng Dr.
Guo Xuefeng MD, PhD
1 373651 Department of Endoscopic Surgery, Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
2 373651 Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
3 373651 Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
Correspondence Xuefeng Guo, MD, PhD Department of Endoscopic Surgery, Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University26 Yuancun Erheng RoadGuangzhou 510655, GuangdongChinaguoxfeng@mail.sysu.edu.cn
19 9 2024
12 2024
1 9 2024
56 Suppl 1 E791E792
The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
2024
The Author(s).
https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Supported by National Key Clinical Discipline, the program of Guangdong Provincial Clinical Research Center for Digestive Diseases2020B1111170004 The Science and Technology Program of Guangzhou2024B03J0562
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pmc A 30-year-old man was admitted with right lower abdominal pain for 2 days. A computed tomography scan showed acute suppurative appendicitis with an enlarged appendix ( Fig. 1 ). At the time, the patient was experiencing an active phase of Crohnʼs disease and was undergoing treatment with ustekinumab, making appendectomy inadvisable. He therefore underwent direct vision endoscopic retrograde appendicitis therapy (ERAT).

Fig. 1 Computed tomography scan image showing acute suppurative appendicitis, with an enlarged appendix (arrow).

Colonoscopy revealed a cobblestone-like appearance of the colonic mucosa, with scattered irregular superficial ulcers covered by a white exudate ( Fig. 2 a ), confirming the diagnosis of active Crohnʼs disease. Once the cecum had been reached, the mucosa of the appendiceal orifice appeared edematous ( Fig. 2 b ). A digital single-operator cholangioscope (eyeMax; Micro-Tech, Nanjing, China), inserted into the appendiceal cavity, was used to perform appendicoscopy ( Video 1 ). Direct visualization provided a clear view of congestion and edema within the appendiceal cavity ( Fig. 3 a ). It also revealed expansion of the lumen and a significant amount of white purulent discharge ( Fig. 3 b ). The appendix was irrigated with metronidazole sodium solution, and a single-pigtail pancreatic stent was placed with guidewire assistance ( Fig. 4 ). Post-ERAT, the patient rapidly experienced pain relief and was discharged without complications.

Fig. 2 Colonoscopic images showing: a evidence of active Crohnʼs disease; b the appendiceal orifice.

Fig. 3 Cholangioscopic image showing: a the mucosa within the appendiceal cavity; b white purulent discharge in the appendiceal cavity.

Fig. 4 Endoscopic image showing a single-pigtail pancreatic stent inserted into the appendix.

A digital single-operator cholangioscope is used to perform appendicoscopy and endoscopic retrograde appendicitis therapy (ERAT).

Video 1

For patients with Crohnʼs disease with severe complications, such as intestinal perforation, persistent or recurrent intestinal obstruction, abdominal abscess not amenable to percutaneous drainage, refractory gastrointestinal bleeding, dysplasia, or cancer, surgical intervention is required. Surgical interventions can potentially result in significant complications, an elevated risk of recurrence, and a diminished quality of life. Direct vision ERAT is an effective treatment for appendicitis. To the best of our knowledge, this is the first report of the use of a digital single-operator cholangioscope to treat Crohnʼs disease with acute appendicitis. In such a situation, this method avoids the need for appendectomy and the potential complications associated with the surgery.

Endoscopy_UCTN_Code_TTT_1AQ_2AF

Conflict of Interest The authors declare that they have no conflict of interest.
