S2280 Efficacy and Safety of Endoscopic Transcecal Appendectomy: A Systematic Review and Meta-Analysis

Introduction: Appendiceal orifice polyps are rare with prevalence of 0.08%. The increased colon cancer screening led to more frequent detection. Surgical approach is the standard approach. Endoscopic Transcecal Appendectomy (ETA) has several potential advantages when compared to surgery including direct visualization of the appendiceal orifice, absence of abdominal incision and an alternative to non-surgical candidates. In this study, we conducted a systematic review and metanalysis to review the efficacy and safety of ETA for the management of appendiceal lesions. Methods: A systematic literature search was conducted across PubMed, Embase, Scopus, Web of Science, and Cochrane databases up to Feb. 28, 2025. Three studies comparing efficacy and safety of ETA for managing appendiceal orifice lesions were included. The primary outcome was the efficacy of ETA in achieving technical success and en-bloc resection. Secondary outcomes included recurrence rate, bleeding events, the mean hospital stay, and adverse events. A single arm meta-analysis was performed using a random-effects model. Results: The total number of participants is 45 patients. The mean age is 61.8 SD (14.22). Females constituted 53.3% of the clinical trials. The mean lesion size is 21.6 mm SD (10.54 mm). Tubular adenoma was the most common type of pathology with 12 adenomas. The achieved technical success rate was 100% (95% CI: 92%–100%) (I² = 0%, τ² = 0, P = 1.000). The en-bloc resection had a success rate of 97% (95% CI: 90%–100%) (I² = 0%, P = 0.5913). The Recurrence rate was 0.0% (95% CI: 0.0%–5.0%) (I² = 0%, P = 1.000). No bleeding events were observed across studies with rates of 0.0% (95% CI: 0.00-0.05) (I² = 0%, P = 1.000). Perforation was observed in 2 of 45 patients with rates of 3.0% (95% CI: 0.0%–9.0%) (I² = 0%, P = 0.475). The mean hospital stay was 7.27 days (95% CI: 2.94-11.6) (I² = 95.8%, P < 0.0001). The average procedure duration was 123.30 minutes (95% CI: 82.37-164.24) (I² = 12 = 91.6%, P < 0.0001). Conclusion: This Meta-analysis shows that ETA is a promising, minimally invasive technique for appendiceal polyps. It demonstrated high efficacy with success rates reaching 100%. It also showed very minimal complication, with absent recurrence or bleeding and low perforation rates of 3%. This technique requires a high level of expertise with advanced endoscopic techniques. Given the limited sample size, future large-scale multicenter studies are warranted to further validate these results and establish a standardized guideline.