Affiliation:
1. Department of Gastroenterology The First Affiliated Hospital of Zhengzhou University Zhengzhou Henan Province China
2. State Key Laboratory of Esophageal Cancer Prevention and Treatment Zhengzhou University Zhengzhou Henan Province China
3. The Second Affiliated Hospital of Harbin Medical University Harbin Heilongjiang Province China
4. The Lianjiang People's Hospital Lianjiang Guangdong Province China
5. Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine Nanning Guangxi Zhuang Autonomous Region China
Abstract
ObjectiveTo compare the efficacy and feasibility of endoscopic retrograde appendicitis therapy (ERAT) with appendectomy for treating acute uncomplicated appendicitis.MethodsThis was a prospective multicenter randomized trial in which consecutive patients were randomized at a ratio of 1:1 to receive either ERAT or appendectomy. The outcomes included technical success rate, procedure time, postoperative pain relief, postoperative analgesic use, time to soft diet intake, length of postoperative hospital stay, postoperative complications, and recurrence rate.ResultsFrom August 2013 to December 2015, 110 patients with acute uncomplicated appendicitis were randomized to ERAT or appendectomy. The technical success rate was 94.55% for ERAT compared with 100% for appendectomy. Recurrence of appendicitis within 3‐year follow‐up occurred in 8 patients following ERAT. Postoperative abdominal pain was less frequent with ERAT than with appendectomy (21.15% [11/52] vs 87.27% [48/55], P < 0.001). Soft diet intake begun earlier after ERAT than appendectomy (6 h vs 48 h, P < 0.001), and post‐procedure hospital stay was shorter (3 days vs 5 days, P < 0.001), as was the use of analgesics postoperatively (9.09% vs 49.09%, P < 0.001).ConclusionsERAT is a feasible, safe, and effective alternative approach for the management of acute uncomplicated appendicitis. Compared with appendectomy, advantages of ERAT include no skin wound, organ preservation, reduced postoperative pain, early food intake, quick recovery, fewer postoperative complications, and shorter post‐procedure hospitalization. The unsolved problem related to ERAT is the recurrence of appendicitis.