Endoscopic retrograde appendicitis therapy for management of acute appendicitis

Background This study investigated the feasibility of endoscopic retrograde appendicitis therapy (ERAT) for the treatment of acute appendicitis. Methods There were 210 patients included who were admitted to our hospital from January 2017 to October 2019 with a diagnosis of acute appendicitis. According to the method of treatment, patients were stratified into the ERAT group, laparoscopic appendectomy (LA) group, or open appendectomy (OA) group for comparison of perioperative information extracted from the medical records of the patients. Results The operations were successfully completed in all patients. The length of operation in the ERAT group (median: 48 min, range: 34-78 min) was significantly shorter compared to the LA group (median: 67 min, range: 47-90 min) or OA group (median: 85 min, range: 58-120 min). Postoperatively, the length of the hospital stay, the amount of time spent bedridden following surgery, surgery-related complications, and in-patient expenses were all significantly less than those in both the LA and OA groups (all p < 0.05). Moreover, the recurrence rate of appendicitis after ERAT was 2.86% during the first six months of postoperative follow-up. Thirteen patients in the ERAT group were diagnosed with appendicular abscesses, all of which successfully proceeded by colonoscopically incising the most protruding or fluctuating place around the appendix opening without procedure-related complications during the follow-up period. Conclusion ERAT is a safe and effective endoscopic treatment method for acute appendicitis and abscesses of the appendix. The advantages include reduced trauma, faster recovery times, and lower costs in comparison with either OA or LA procedures. ERAT with internal incision and drainage can be safely performed with immediate effect, especially in patients with acute uncomplicated appendicitis accompanied by either fecal stones or stenosis of the appendix cavity, or an abscess within the appendix cavity.