Endoscopic retrograde appendicitis therapy changing outlook for Appendicitis treatment compared to Laparoscopy.

Endoscopic retrograde appendicitis therapy (ERAT) was found to be technically feasible and changed the treatment perspective of uncomplicated acute appendicitis when compared to laparoscopic surgery as per a study published in the journal, "Endoscopy." 

ERAT is a novel and minimally invasive technique for the treatment of acute appendicitis. So, researchers from China conducted a study to assess the efficacy and clinical outcomes of ERAT versus laparoscopic appendectomy for patients with uncomplicated acute appendicitis. The study was carried out between April 2017 and March 2020. Using propensity score matching, out of 2880 suspected acute appendicitis patients, 422 patients with uncomplicated acute appendicitis who met the matching criteria were included with 79 in ERAT and 343 in Laparoscopic appendectomy thus yielding 78 pairs of patients. 

Results: 

• ERAT had a 92.1% of curative treatment rate within 1 year. 
• 94.7% of patients recorded a visual analog scale of ≤ 3 for pain at 6 hours after treatment in the ERAT group which was significantly higher than that in the laparoscopic appendectomy group. 
• Median procedure time and median hospital length of stay were significantly lower in the ERAT group compared with the laparoscopic appendectomy group. 
• The median recurrence time was 50 days in the ERAT group at 1 year. 
• The overall adverse event rate was 18.4 % in the ERAT group and 24.4 % in the laparoscopic appendectomy group. 

Take home points: 

• This non-inferiority retrospective study compared the clinical outcomes of endoscopic retrograde appendicitis therapy (ERAT) with those of standard laparoscopic appendectomy (LA) for uncomplicated acute appendicitis in 422 patients (79 underwent ERAT and 343 underwent LA).
• Overall, 97.4% of the patients underwent successful appendiceal intubation and 92.1% of the patients did not require surgery within 1 year of ERAT compared with 100% for LA.
• At a 11% non-inferiority margin, ERAT was non-inferior to LA.
• Overall, 63.2% of the patients undergoing ERAT underwent saline flushing into the appendiceal lumen, whereas the other 36.8% also had a stent placed.
• Among patients who underwent saline flushing alone, 7.9% redeveloped appendicitis with a median recurrence time of 50 days.
• There were no significant differences in short-term adverse event rates between the two therapies and only 1 patient undergoing ERAT developed an appendiceal perforation (1.3%).
• The patients who underwent ERAT reported a significantly lower degree of abdominal pain and had lower hospitalization durations than patients who underwent LA.
• ERAT appears to be a promising therapy for uncomplicated acute appendicitis. However, a randomized controlled study with larger sample size is needed to further evaluate this treatment modality.  

To read the full article, click here: 10.1055/a-1759-2859

Podda M. Endoscopic retrograde appendicitis therapy: a starting point for a change of perspective in treating acute appendicitis (and beyond). Endoscopy. 2022;54(8):755-756.