Abstract
A 51-year-old man was referred to our institution for removal of a large semipedunculated polyp (0-Isp) involving the appendiceal orifice ([Fig. 1]). Previous biopsies showed a tubulovillous adenoma (TVA) with high grade dysplasia (HGD). Endoscopic resection under general anesthesia in the operating room was proposed and was agreed to by the patient. A 30-mm 0-Isp lesion extending into the appendix (> 75 % of orifice) was found, with narrowband imaging showing a regular mucosal pattern without areas suggestive of deep invasion. Different endoscopic resection techniques were discussed at this point, such as endoscopic full-thickness resection (EFTR) and endoscopic submucosal dissection (ESD). However, the size, involvement of the appendiceal orifice, and presence of identifiable margins of the lesion favored conventional endoscopic mucosal resection (EMR) ([Video 1]).
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