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Endoscopic retrograde appendicitis therapy: a pilot minimally invasive technique (with videos)
Bing-Rong Liu1, Ji-Tao Song, Fu-You Han
1Digestive Endoscopy Center, Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China. 13704510648@126.com
Background:
Inspired by the success of ERCP for the treatment of suppurative cholangitis, we investigated a new minimally invasive method for the treatment of acute uncomplicated appendicitis, which we call endoscopic retrograde appendicitis therapy.
Objective:
To investigate the feasibility and efficacy of endoscopic retrograde appendicitis therapy for the treatment of acute uncomplicated appendicitis.
Design And Setting:
A retrospective, single-center study at an academic medical center.
Patients:
Four patients with acute uncomplicated appendicitis.
Interventions:
There were 5 steps after insertion of a colonoscope into the cecum and identification of the appendiceal orifice: (1) endoscopic appendiceal intubation; (2) appendiceal decompression; (3) retrograde appendicography; (4) stent drainage; and (5) cleansing the appendiceal lumen.
Main Outcome Measurements:
The rate of successful endoscopic intubation and decompression, the time to symptom relief, the time to disappearance of signs, increased white blood cell count, procedure-related complications, and recurrence, if any.
Results:
All 4 endoscopic appendiceal intubations were successful. Pain was relieved immediately after endoscopic decompression and stent drainage. Leukocytosis returned to normal within 24 hours. There were no complications and no recurrences during 4 to 19 months of follow-up.
Limitations:
Small sample size, single-center study without controls.
Conclusion:
Endoscopic retrograde appendicitis therapy is a feasible and effective endoscopic treatment modality for acute uncomplicated appendicitis.
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