Background As the novel coronavirus disease 19 (COVID-19) spreads, a decrease in the number of patients with acute appendicitis (AA) has been noted in our institutions. The aim of this study was to compare the incidence and severity of AA before and during the COVID-19 pandemic. Methods A retrospective cohort analysis was performed between December 2019 and April 2020 in the four highvolume centres that provide health care to the municipality of Jerusalem, Israel. Two groups were created. Group A consisted of patients who presented in the 7 weeks prior to COVID-19 first being diagnosed, whilst those in the 7 weeks after were allocated to Group B. A comparison was performed between the clinicopathological features of the patients in each group as was the changing incidence of AA. Results A total of 378 patients were identified, 237 in Group A and 141 in Group B (62.7% vs. 37.3%). Following the onset of COVID-19, the weekly incidence of AA decreased by 40.7% (p = 0.02). There was no significant difference between the groups in terms of the length of preoperative symptoms or surgery, need for postoperative peritoneal drainage or the distribution of complicated versus uncomplicated appendicitis. Conclusions The significant decrease in the number of patients admitted with AA during the onset of COVID-19 possibly represents successful resolution of mild appendicitis treated symptomatically by patients at home. Further research is needed to corroborate this assumption and identify those patients who may benefit from this treatment pathway.

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Aim: To compare gallstones removal rate and incidence of bleeding, pancreatitis, use of mechanical lithotripsy, cholangitis and perforation between isolated sphincterotomy versus sphincterotomy associated with balloon dilation of papilla in choledocholithiasis through the meta-analysis of randomized clinical trials. Methods: We conducted a systematic review according to the PRISMA guidelines. Literature search was restricted to randomized controlled trials (RCTs) on MedLine, Cochrane Library, LILACS, and EMBASE database platforms in July 2017. Eligibility criteria: Participants: patients with choledocholithiasis, older than 18 years. Interventions and comparisons: to compare endoscopic isolated sphincterotomy vs endoscopic sphincterotomy associated with balloon dilation. All relevant articles were accessed in full text. The manual search included references of retrieved articles. We extracted data focusing on outcomes: The primary endpoint was the stones removal rate; Secondary endpoints were rates of pancreatitis, bleeding, use of mechanical lithotripsy (ML), perforation and cholangitis. We analyzed the data and reported the results in tables and text. Results: Nine RCTs with a total of 1230 patients were included. Data analysis of the included studies showed that there was no statistical difference in safety between the two methods, since the incidence of pancreatitis (FE RD -0.01, CI [-0.03, 0.02], I 2 Z 0, p Z 0.5), bleeding (FE RD -0.01, CI [-0.03, 0.01], I 2 Z 32%, p Z 0.25), cholangitis (FE RD 0.00, CI[-0.01, 0.01], I 2 Z0, p Z 0.98) and perforation (FE RD -0.01, CI [-0.02, 0.01], I 2 Z0, p Z 0.37) was similar between the groups, but it was evident that there was a difference in efficacy, not quantitatively, with similar removal rates of gallstones in general and for subgroups greater than 15mm (FE RD 0.01, CI [-0.02, 0.04], I 2 Z 0, p Z 0.59) and (FE RD 0.02, CI [-0.04, 0.07], I 2 Z 5%, p Z 0.52), respectively, but perhaps qualitative, since there was less need for mechanical lithotripsy in the ESBD group (RE RD -0.14, CI [-0.25, -0.03], I 2 Z 91%, p Z 0.01), with a consequent theoretical decrease in exposure to adverse events resulting from it. Conclusion: There was no difference in the stone removal rate and incidence of bleeding, pancreatitis, cholangitis and perforation between isolated sphincterotomy and sphincterotomy associated with balloon dilation in the approach to remove gallstones. However, there was less use of mechanical lithotripsy in patients with choledocholithiasis submitted to sphincterotomy associated with balloon dilation.