Prophylactic appendiceal retrograde intraluminal stent placement “PARIS”

Supporting the EFTR procedure to reduce appendicitis – Prophylactic appendiceal retrograde intraluminal stent placement “PARIS”

Margaret G. Keane et al., John Hopkins Hospital, Department of Gastroenterology and Hepatology Baltimore, Maryland, published a video case report on intraluminal stent placement in the appendix to support the EFTR procedure and potentially reduce the risk of appendicitis.

The case video and pictures can be found here: videogie.org/article/S2468-4481(21)00183-1/fulltext

While polyps developing from the appendiceal orifice are difficult to treat with EMR or ESD, the FTRD System can offer a treatment approach by deploying an over-the-scope clip before resection and therefore reducing the risk of perforation. However, appendicitis can occur as an adverse event and was reported in 0 – 50% of cases often requiring immediate treatment in form of appendectomy. The authors speculate, that the FTRD clip is restricting outflow from the appendix causing appendicitis, with a peak onset within one to two weeks after the procedure.

To reduce the risk of appendicitis Keane et al. decided to treat a patient with a tubular adenoma extending into the appendiceal lumen using EFTR combined with prophylactic appendiceal retrograde intraluminal stent placement for drainage. After the insertion of a plastic biliary stent, the polyp was resected with the FTRD while the plastic stent remained adjacent to the clip in the appendix lumen. As stated by the author, placement of a stent in the appendiceal lumen can potentially maintain drainage of the appendix and reduce the risk of appendicitis. The stent spontaneously migrated as ascertained at a 3-week checkup while the clip was still in situ. After thorough examination of the polyp site there could be no residual adenomatous tissue found.

The authors concluded that this technique may have its use case in patients with hostile abdomens and high-risk surgical candidates but must be validated in further cases and prospective studies.

Prophylactic appendiceal retrograde intraluminal stent placement (PARIS).
Keane MG, Mony S, Wood LD, Kumbhari V, Khashab MA.
VideoGIE. 2021 Oct 14;6(12):552-554.
ncbi.nlm.nih.gov/pmc/articles/PMC8646081/