Endoscopic retrograde appendicitis therapy in adults with uncomplicated acute appendicitis: a systematic review and...

Endoscopic retrograde appendicitis therapy (ERAT) has emerged as a minimally invasive endoscopic alternative to laparoscopic appendectomy in the treatment of acute appendicitis. In this systematic review and meta-analysis, we evaluated the efficacy and safety of ERAT in treating uncomplicated acute appendicitis.

A systematic review of studies in the PubMed/MEDLINE and Cochrane databases was performed through June 2023. Primary outcomes were clinical success rate (defined as resolution in signs and symptoms of appendicitis) and technical success rate (defined as successful placement of a drain or stent within the appendicular orifice or irrigation to relieve appendiceal obstruction). Secondary outcomes were adverse event rates and rates of intestinal perforation, procedure time, hospital length of stay, duration of follow-up, and rates of appendicitis recurrence after ERAT.

Eight studies were considered eligible for analysis (326 patients, average age of 36.4 years old, 55.4% men). The rate of technical success was 98% (95% confidence interval [CI], 97-100; I ² = 2.2%), and the rate of clinical success was 99% (95% CI, 97-100; I ² = 0%). The total pooled adverse event rate was 1.8% (95% CI, .4-3.2; I ² = 0%) with a pooled intestinal perforation rate of 1.5% (95% CI, .02-2.8; I ² = 0%). The average procedure time was 44.9 minutes. The average hospital length of stay after ERAT was 3.22 days. The aggregate rate of appendicitis recurrence after ERAT was 6% (95% CI, 3-9; I ² = 16.5%) after an average follow-up of 17.7 months.

ERAT demonstrated excellent technical and clinical success rates with minimal adverse events. Additional randomized controlled studies are needed to refine inclusion criteria and to standardize the approach to appendiceal stent placement during ERAT to minimize rates of intestinal perforation.