Endoscopic retrograde appendicitis therapy for acute appendicitis: a systematic review and meta-analysis

Dhindsa, Banreet; Naga, Yassin; Praus, Alexander; Saghir, Syed Mohsin; Mashiana, Harmeet S.; Ramai, Daryl; Chandan, Saurabh; Sayles, Harlan; Dhaliwal, Amaninder; Bhat, Ishfaq; Singh, Shailender; Adler, Douglas G.

doi:10.1055/a-1819-8231

Cited by 10 publications

(5 citation statements)

References 33 publications

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“…7 However, the risk of recurrence of acute appendicitis remains a challenge and has been estimated to be between 6.01% and 7.9%. [8][9][10] However, it could be decreased by appendiceal stent placement. 9 Further studies are needed to establish indications for appendiceal stent placement and identify factors associated with recurrence.…”

Section: Discussionmentioning

confidence: 99%

Successful Endoscopic Retrograde Appendicitis Therapy Following a Recent ST-Elevation Myocardial Infarction

Suarez,

Samhoun,

Drourr

et al. 2024

ACG Case Rep J

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Acute appendicitis is one of the most common abdominal surgical emergencies. A laparoscopic or open appendectomy has traditionally been the gold standard. Antibiotic therapy has recently been found to be noninferior. The treatment of acute uncomplicated appendicitis remains a challenge, especially in the presence of an appendicolith. We present a case of a 59-year-old man with recent ST-elevation myocardial infarction who underwent successful endoscopic retrograde appendicitis therapy.

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Section: Discussionmentioning

confidence: 99%

Successful Endoscopic Retrograde Appendicitis Therapy Following a Recent ST-Elevation Myocardial Infarction

Suarez,

Samhoun,

Drourr

et al. 2024

ACG Case Rep J

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“…The pooled technical and clinical success of ERAT for AUA from 7 studies (298 patients) was as high as 99%, with a 6% (range, 2.9%-9.9%) recurrence rate. This is likely a projection of achieving source control, either by repeated flushing of the appendiceal lumen or by stent deployment . In our experience, recurrent appendicitis had been noted in patients who did not undergo stent placement with ERAT, highlighting the need for standardization of indications for appendiceal stent deployment .…”

mentioning

confidence: 80%

Management of Acute Uncomplicated Appendicitis

2023

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To the Editor We read with the great interest the systematic review and meta-analysis by de Almeida Leite and colleagues, 1 who suggest that nonoperative management of acute uncomplicated appendicitis (AUA) is comparable with surgery without an increase in major complications, albeit with a longer hospital stay and a cumulative appendicitis recurrence rate of 18%, highlighted by the authors as 2 major limitations of this treatment approach.The efficacy of antibiotic therapy in adults with AUA ranges from 63% to 85%. 2,3 Appendicitis is often a consequence of obstruction by an appendicolith or appendiceal lumen narrowing, which creates a milieu for microbial proliferation. In such a setting, antibiotics alone cannot achieve source control, which may explain the high recurrence rate seen with nonoperative management of AUA.A 5-year follow-up of the Appendicitis Acuta (APPAC) trial 3 showed a 39% probability of late recurrence in patients initially treated with antibiotics. Beyond recurrent appendicitis, there remains the risk of abscess formation and perforation. The notable inconsistency in the studies included in the current systematic review and meta-analysis is also worth highlighting, which undoubtedly impacts the certainty of the findings supporting the adoption of antibiotic therapy. Consequently, the population of patients with AUA that can truly benefit from antibiotics alone may be limited.Endoscopic retrograde appendicitis therapy (ERAT) is a promising noninvasive treatment modality for AUA. 4 The pooled technical and clinical success of ERAT for AUA from 7 studies (298 patients) was as high as 99%, with a 6% (range, 2.9%-9.9%) recurrence rate. This is likely a projection of achieving source control, either by repeated flushing of the appendiceal lumen or by stent deployment. 5 In our experience, recurrent appendicitis had been noted in patients who did not undergo stent placement with ERAT, highlighting the need for standardization of indications for appendiceal stent deployment. 4 Furthermore, ERAT can be extended to perform appendicoscopy, which allows direct visualization of the appendiceal mucosa and carries diagnostic and therapeutic implications.It is pivotal to follow established principles of achieving source control in addition to antibiotic therapy for obstructive pathologies such as appendicitis. ERAT should be considered an efficacious and safe modality while approaching management of AUA as a therapeutic alternative and for diagnostic evaluation of the appendix as part of a noninvasive management strategy. With appropriate patient selection, ERAT can be performed as an outpatient procedure, which should incentivize training and adoption of this approach in the US Western countries.

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“…Endoscopic retrograde appendicitis therapy (ERAT) is a minimally invasive procedure for treating appendicitis, with reported success rates ranging from 92.1% to 99.36% and low complication rates [106][107][108]. ERAT has also demonstrated advantages over laparoscopic appendectomy, including better pain outcomes and shorter hospitalization.…”

Section: Endoscopic Retrograde Appendicitis Therapy (Erat)mentioning

confidence: 99%

Typical and Atypical Presentations of Appendicitis and Their Implications for Diagnosis and Treatment: A Literature Review

Echevarria†¹,

Rauf†²,

Hussain³

et al. 2023

Cureus

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Appendicitis, an acute inflammation of the appendix, affects all demographic groups and exhibits various incidences and clinical manifestations. While acute appendicitis typically presents with colicky periumbilical abdominal pain that localizes to the right lower quadrant, atypical presentations are more common in children, geriatric, and pregnant patient populations, leading to delays in diagnosis. Clinical evaluation, clinical scoring systems, and inflammatory markers are commonly used, but their limitations have led to the increased use of diagnostic imaging in patients suspected of appendicitis. Acute appendicitis is managed by non-operative and operative management, depending on whether it is uncomplicated or complicated. Developing diagnostic pathways to improve outcomes and reduce complications is crucial. Although medical advancements have been made, diagnosing and managing appendicitis can be challenging, mainly when patients are present atypically. This literature review aims to comprehensively review typical and atypical presentations of appendicitis and their current implications for diagnosis and treatment modalities in pediatric, adult, pregnant, and geriatric patient populations.

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Endoscopic retrograde appendicitis therapy for acute appendicitis: a systematic review and meta-analysis

Cited by 10 publications

References 33 publications

Successful Endoscopic Retrograde Appendicitis Therapy Following a Recent ST-Elevation Myocardial Infarction

Successful Endoscopic Retrograde Appendicitis Therapy Following a Recent ST-Elevation Myocardial Infarction

Management of Acute Uncomplicated Appendicitis

Typical and Atypical Presentations of Appendicitis and Their Implications for Diagnosis and Treatment: A Literature Review

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