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

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.