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Endoscopic resection of the lesion on the inverted appendix using an endoloop

APPENDICEAL INVERSION IS uncommon and has been reported to occur at a prevalence of approximately 0.01% in patients undergoing appendectomy. Herein, we report a case of an appendiceal adenoma developing from an inverted appendix, which was treated by endoscopic appendectomy using an endoloop (Olympus, Tokyo, Japan) and a snare. A 72-year-old man was referred to our hospital for the management of a cecal tumor. Endoscopy revealed a pedunculated polyp with a thick stalk; the lesion, which measured 35 mm in diameter, had a reddish and lobular surface (Fig. 1A). Since the orifice of the appendix could not be identified, we suspected that the stalk was the inverted appendix (Fig. 1B). Computed tomography (CT) showed an intraluminal structure in the cecum suggestive of an inverted appendix (Fig. 1C). The procedure is shown in Video S1. Since CT showed the thick artery within the inverted appendix and we were concerned about the bleeding after endoscopic resection (ER), we ligated the inverted appendix using an endoloop. Since we did not observe any color change of the lesion after the first ligation, we ligated it doubly (Fig. 1D). After confirming the