Author response: Endoscopic appendix opening sphincter incision to remove faecolith

Correspondence to: Gang Bian (e-mail: bianganglingling@163.com)

Department of Gastroenterology

Qingdao Third People's Hospital Affiliated to Qingdao University

No. 29

Yongping Road

Licang District

Qingdao 266000

Shandong Province

China

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BJS, https://doi.org/10.1093/bjs/znaf012, published 10 February 2025

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We thank the authors for their comments about our paper and have the following comments. While recurrence is a recognized concern, current studies suggest that the recurrence rate following endoscopic retrograde appendicitis treatment (ERAT) is significantly lower than that of antibiotic therapy1. Furthermore, although retaining the appendix may pose a potential risk for future inflammation or neoplasia, organ removal should not be undertaken solely due to the presence of inflammation. In the absence of gangrenous changes or a confirmed diagnosis of malignancy, prophylactic appendicectomy lacks sufficient justification.

In this case, preoperative evaluation suggested that the appendiceal orifice might be obstructed by a foreign body or mass. However, intraoperative findings confirmed that a faecolith was occluding the appendiceal lumen. In alignment with the concept of ultra-minimally invasive therapy, the faecolith was successfully extracted, thereby avoiding surgical appendicectomy and preserving the organ. Notably, the appendiceal lumen is anatomically continuous with the intestinal tract and lacks a defined sphincteric structure at its opening, unlike the biliary orifice. As this is a typical case, we aim to contribute to the body of knowledge through long-term follow-up and further investigation, with the goal of providing safer and more effective treatment strategies for similar patients.

No recurrent symptoms of abdominal pain or other discomfort have been reported in follow-up to date. This patient has not suffered from acute appendicitis.