BACKGROUND Previous studies had shown endoscopic retrograde appendicitis therapy (ERAT) is an effective treatment for acute appendicitis. However, different studies reported conflicting outcomes regarding the effectiveness of ERAT in comparison with laparoscopic appendectomy (LA). AIM To compare the effectiveness of ERAT with LA. METHODS Randomized controlled trials (RCTs) and retrospective studies of ERAT for acute uncomplicated appendicitis were searched in PubMed, Cochrane Library, Web of Science, Embase database, China National Knowledge Infrastructure (CNKI), the WanFang Database, and Chinese Scientific Journals Database (VIP) from the establishment date to March 1 2021. Heterogeneity was assessed using the I-squared statistic. Pooled odds ratios (OR), weighted mean difference (WMD), and standard mean difference (SMD), with 95% confidence intervals (CI) were calculated through either fixed-effects or random-effects model. Sensitivity analysis was also performed. Publication bias was tested by Egger's test, and Begg’s test. The quality of included RCT were evaluated by the Jadad scale, while Newcastle-Ottawa scale is adopted for assessing the methodological quality of case-control studies. All statistical analysis was performed using Stata 15.1 statistical software. All statistical analysis was performed using Stata 15.1 statistical software. This study is registered with PROSPERO, CRD42021243955. RESULTS After screening, 10 RCTs and 2 case-control studies were included in the current systematic review. Firstly, the length of hospitalizations [WMD = -1.15, 95%CI: -1.99, -0.31; P = 0.007] was shorter than LA group. Secondly, the level of post-operative CRP [WMD = -10.06, 95%CI: (-17.39, -2.73); P = 0.007], TNF-α [WMD = -7.70, 95%CI: (-8.47, -6.93); P < 0.001], and IL-6 Levels [WMD = -9.78, 95%CI: (-10.69, -8.88); P < 0.001; P < 0.001] in ERAT group was significantly lower than LA group. Thirdly, ERAT group had a lower incidence of intestinal obstruction than LA group. [OR = 0.19, 95%CI: (0.05, 0.79); P = 0.020]. Moreover, the quality of 10 RCTs were low with 0-3 Jadad scores, while the methodological quality of two case-control studies were fair with a score of 2 (each). CONCLUSION Compared with LA, ERAT reduces operation time, the level of postoperative inflammation, and results in fewer complications and shorter recovery time, with preserving the appendix and its immune and biological functions.

Before institution of universal patient surveillance, patients detected outside the isolation ward over a 6-month period (January-June 2020) spent an average of 16.5 hours (N = 32; SD, 9.76) in the general ward prior to isolation, with 68 inpatient close contacts identified; 1 inpatient's close contact subsequently tested positive within the incubation period. 8,9 During the universal surveillance period, asymptomatic inpatients spent an average of 2 hours (N = 5; SD, 1.87) prior to isolation, a difference that was statistically significant (−14.6; 95% CI, −23.5 to −5.6; P = .002). In total, 26 inpatient close contacts were identified and placed under quarantine; none tested positive.In conclusion, institution of RRT for all HCWs as well as universal screening for COVID-19 in all inpatients during a 6-week period of increased transmission in the surrounding community detected additional asymptomatic cases among HCWs and inpatients. Although the yield of testing was not high, earlier detection of asymptomatic inpatient cases allowed for faster isolation, limiting potential exposure. No clusters of COVID-19 infections were seeded among staff or patients during a period of heightened risk. Although RRT and universal screening for all inpatients is resource intensive (Fig. 1c), there may be a role for such measures during increased community transmission, given that healthcare institutions are inextricably intertwined with their neighboring communities.

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