Endoscopic retrograde appendicitis therapy versus laparoscopic appendectomy versus open appendectomy for acute appendicitis: a pilot study

Abstract

Background An increasing number of studies have shown the merits of endoscopic retrograde appendicitis therapy (ERAT) in diagnosing and treating acute uncomplicated appendicitis. However, no related prospective controlled studies have been reported yet. Our aim is to assess the feasibility and safety of ERAT in the treatment of acute uncomplicated appendicitis. Methods In this open-label, randomized trial, participants were randomly allocated to the ERAT group, laparoscopic appendectomy (LA) group and open appendectomy (OA) group. The primary outcome was the clinical success rate of the treatment. Intention-to-treat analysis was used in the study. Results The study comprised of 99 patients, with 33 participants in each group. The clinical success rate was 87.88% (29/33), 96.97% (32/33) and 100% (33/33) in the ERAT, LA and OA group, respectively. In the ERAT group, 4 patients failed ERAT due to difficult cannulation. In LA group, 1 patient failed because of abdominal adhesion. There were no significant differences among the three treatment groups regarding the clinical success rate (P = 0.123). The median duration of follow-up was 22 months. There were no significant differences (P = 0.693) among the three groups in terms of adverse events and the final crossover rate of ERAT to surgery was 21.21% (7/33). Conclusion ERAT can serve as an alternative and efficient method to treat acute uncomplicated appendicitis. Trial registration The study is registered with the WHO Primary Registry-Chinese Clinical Trial Registry (ChiCTR1900025812).

Endoscopic Retrograde Appendicitis Therapy

“…Retained appendiceal stents are removed by endoscopy. Although data is scarce, in the open-label clinical trial by Shen et al, 26 the reported a stent retention rate was 69%. Establishing indications for appendiceal stent placement and identifying factors associated with recurrent appendicitis and appendiceal stent retention will be critical aims for future studies to improve outcomes of ERAT.…”

“…ERAT has now been widely adopted in China. The technical success (successful intubation of appendix and successful drainage of the appendiceal cavity) and clinical success (improvement in abdominal pain, nausea, and fever) of ERAT is as high as 99% for AUA 21–30. Most ERAT cases in China are performed on an outpatient basis.…”

“…The technical success (successful intubation of appendix and successful drainage of the appendiceal cavity) and clinical success (improvement in abdominal pain, nausea, and fever) of ERAT is as high as 99% for AUA. [21][22][23][24][25][26][27][28][29][30] Most ERAT cases in China are performed on an outpatient basis. However, it is advisable to triage patients appropriately.…”

Effect of endoscopic retrograde appendicitis therapy on surgical site wound infection and hospital stay in patients with acute appendicitis: A meta‐analysis

“…9,10 Its benefits include minimal invasiveness, convenience, organ preservation, and a low postoperative infection rate, making it favoured among clinicians. 11 Moreover, ERAT has garnered considerable attention because it promptly relieves patients' pain by alleviating appendiceal pressure. 9 Thus, ERAT has gradually been applied in clinical practice.…”

Authors’ Reply: Evolving Trends in the Management of Acute Appendicitis During COVID‐19 Waves: The ACIE Appy II Study

“…Most of the studies included few patients and were mainly from China, making worldwide generalization questionable. The most recent randomized trial published by Shen et al [ 6 ] including 33 patients undergoing ERAT is a “pilot study”, implicitly assuming that a larger study is necessary to confirm its findings in favor of the technique.…”