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The modified endoscopic retrograde appendicitis therapy versus antibiotic therapy alone for acute uncomplicated
Jianqin Kang1, Wei Zhang1, Lingchao Zeng2
1Department of Pediatrics, Tangdu Hospital, Fourth Military Medical University, 1 Xinsi Road, Xi'an, 710038, Shaanxi Province, China.
Insights
Modified endoscopic retrograde appendicitis therapy (mERAT) offers a safe and effective treatment for acute uncomplicated appendicitis in children. This innovative approach shows a higher success rate and shorter hospital stays compared to traditional antibiotic therapy.
Area of Science:
- Pediatric Gastroenterology
- Minimally Invasive Surgery
- Endoscopic Therapeutics
Background:
- Acute uncomplicated appendicitis (AUA) in children lacks robust comparative studies for endoscopic treatments.
- Ionizing radiation concerns in pediatric patients necessitate alternative imaging to radiography.
- Endoscopic retrograde appendicitis therapy (ERAT) is an emerging modality with limited pediatric data.
Purpose of the Study:
- To compare the safety and feasibility of modified ERAT (mERAT) against antibiotic therapy for pediatric AUA.
- To evaluate mERAT as a viable alternative to appendectomy for children.
- To assess clinical outcomes and patient recovery in a pediatric AUA cohort.
Main Methods:
- A prospective randomized control trial was conducted enrolling children with AUA.
- Patients were randomized to receive either mERAT or standard antibiotic treatment.
- Outcomes measured included pain relief duration, treatment success rates, and adverse events, utilizing contrast-enhanced ultrasound (CEUS).
Main Results:
- The mERAT group demonstrated a 100% treatment success rate, significantly higher than the 80.9% in the antibiotic group (P=0.004).
- Children treated with mERAT had a significantly shorter median time to discharge (6.0 ± 1.76 days) compared to the antibiotic group (P=0.004).
- Nine patients initially treated with antibiotics showed poor response and were successfully switched to mERAT.
Conclusions:
- Modified ERAT (mERAT) presents a promising alternative therapeutic option for childhood AUA.
- This endoscopic approach is particularly suitable for families hesitant about surgical appendectomy.
- mERAT offers a safe, feasible, and effective treatment for pediatric AUA with superior outcomes.
Background:
Endoscopic retrograde appendicitis therapy (ERAT) is an emerging endoscopic treatment modality for acute uncomplicated appendicitis (AUA) supported by several case series. However, to date, systematic studies have not been conducted in children and the prospective comparative data are lacking. Moreover, due to a concern for future malignancy risk in children from ionizing radiation, we used contrast-enhanced ultrasound (CEUS) instead of endoscopic retrograde appendiceal radiography (ERAR). Therefore, we conducted a prospective, randomized control clinical trial to compare the modified ERAT (mERAT) to antibiotic therapy in children with AUA. The aim of this study was to evaluate the safety and feasibility and of mERAT in the treatment of hospitalized children with AUA.
Methods:
Children with AUA, confirmed by ultrasonography and or abdominal computed tomography, were consecutively enrolled from October 2018 to February, 2020. They were randomly assigned to receive mERAT or routine antibiotic treatment. Patients were followed until May, 2020. Th primary outcome variable was the duration of relief of the abdominal pain after treatment. We collected patient's demographics, ultrasonic imaging findings, colonoscopy findings, and treatment outcomes of the mERAT and adverse even associated with mERAT.
Results:
A total of 83 children were enrolled. 36 were randomized to mERAT and 47 to antibiotics treatment. All children in the mERAT group had endoscopic confirmed acute uncomplicated appendicitis, and there were no significant complications. However, 9 of patients in antibiotic group were poor responsive to treatment and switched to mERAT. The overall success rate of treatment with mERAT (100%) was significantly higher than that of antibiotics (80.9%) (P = 0.004). The median time to discharge was significantly shorter in mERAT group than in antibiotics treatment group [6.0 ± 1.76 days] (P = 0.004).
Conclusions:
mERAT provide a new alternative therapeutic option for childhood with AUA, especially for families who are reluctant to undergo an appendectomy.
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