Loop-tipped guidewire-assisted cannulation of disposable imaging catheter into appendiceal lumen for difficult endoscopic retrograde appendicitis therapy

Abstract

Figures

Loop-tipped guidewire-assisted cannulation of disposable imaging catheter into the appendiceal lumen. a Computed tomography showing dilated appendix (14 mm). b Loop-tipped guidewire modification. c Edematous appendiceal orifice on colonoscopy. d Successful catheter cannulation. e Endoscopic view of purulent debris. f Deployed single-pigtail stent.

Full text

Endoscopic retrograde appendicitis therapy (ERAT) is an emerging minimally invasive approach for the diagnosis and treatment of acute appendicitis 1 . The disposable imaging catheter provides direct visualization of the appendiceal lumen, enabling irrigation, fecalith removal, and stent placement 2 . Similarly to endoscopic retrograde cholangiopancreatography (ERCP), cannulation in ERAT remains challenging due to edematous or stenotic appendiceal orifices 3 . This report describes a novel technique using a loop-tipped guidewire to guide a disposable imaging catheter to the appendiceal orifice during difficult intubation, facilitating successful cannulation.

A 24-year-old man with a 5-day history of right lower quadrant pain declined surgery in favor of conservative management. Computed tomography showed appendiceal dilation (14 mm) with peri-appendiceal inflammation ( Fig. 1 a ). ERAT was proposed as an alternative therapeutic approach.

Loop-tipped guidewire-assisted cannulation of disposable imaging catheter into the appendiceal lumen. a Computed tomography showing dilated appendix (14 mm). b Loop-tipped guidewire modification. c Edematous appendiceal orifice on colonoscopy. d Successful catheter cannulation. e Endoscopic view of purulent debris. f Deployed single-pigtail stent.

A standard ERCP guidewire (Jagwire; Boston Scientific, Marlborough, Massachusetts, USA) was manually shaped to form a loop at its tip ( Fig. 1 b ). Colonoscopy identified a severely edematous and hyperemic appendiceal orifice ( Fig. 1 c ). The disposable imaging catheter failed to access the appendiceal lumen. The loop-tipped guidewire was advanced through the stenotic orifice using its rounded contour and hydrophilic coating to navigate mucosal folds ( Video 1 ). The disposable imaging catheter (ClearPath; Micro-Tech, Nanjing, China) was then threaded over the guidewire into the appendiceal lumen ( Fig. 1 d , Video 1 ). Direct visualization confirmed extensive purulent debris ( Fig. 1 e ), which was irrigated with metronidazole until clear effluent was observed. A 5 Fr × 5 cm single-pigtail plastic stent was then deployed for drainage ( Fig. 1 f ).

Loop-tipped guidewire-assisted cannulation of disposable imaging catheter into appendiceal lumen for difficult endoscopic retrograde appendicitis therapy.Video 1

The patient had immediate postoperative pain relief, with discharge on Day 1. The stent passed spontaneously by Day 4, and 2-week follow-up confirmed complete symptom resolution.

The loop-tipped guidewire displaces mucosa to create a catheter advancement track, minimizing trauma. Its hydrophilic coating and loop design reduce mucosal adhesion in tortuous/inflamed anatomy, guiding the imaging catheter to complete appendiceal cannulation. The simplicity, safety, and efficiency of the technique warrant broader clinical adoption.

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