Feasibility and safety of endoscopic retrograde appendiceal foreign body removal in children

Endoscopic retrograde appendicitis therapy (ERAT), developed for acute appendicitis, enables minimally invasive access to the appendix for diagnosis and therapy. Based on the ERAT technique, endoscopic retrograde appendiceal foreign body removal has emerged as a logical yet technically advanced extension, offering a potential minimally invasive alternative to surgical appendectomy. The aim of this study was to evaluate the efficacy and safety of endoscopic retrograde appendiceal foreign body removal in children with appendiceal foreign bodies.

This retrospective case series included six children (n = 6) who underwent endoscopic retrograde appendiceal foreign body removal at Xi'an Children's Hospital between January 2022 and May 2025. Clinical data, imaging findings, and procedural details were analyzed.

Six male patients (9.2 ± 2.2 years) were included. One patient had a clear history of foreign body ingestion but was asymptomatic. Five patients denied foreign body ingestion history and presented with varying degrees of right lower quadrant or diffuse abdominal pain. All procedures were successful without perioperative complications. Mean procedure duration was 77.5 ± 41.9 min. Retrieved foreign bodies included a wooden strip, button battery, fruit peel, metal object, fruit shell, and pinworms. Average postoperative hospitalization was 3.2 ± 1.5 days. No patient experienced recurrence of symptoms, appendicitis, or complications during the 6-month follow-up.

Endoscopic retrograde appendiceal foreign body removal appeared feasible in this small series for removing non-sharp appendiceal foreign bodies with low-grade impaction in children, preserving appendiceal function and avoiding surgery.