A multicenter real-world study on the clinical efficacy of endoscopic retrograde appendicitis therapy (erat) for the treatment of appendicitis in china

Aims Appendicitis is a common disease with a 7-10% lifetime prevalence. Endoscopic Retrograde Appendicitis Therapy (ERAT) emerged as a minimally invasive alternative for appendicitis. This study aims to evaluate the efficacy and safety of ERAT, presenting results from multicenter trials in China with the longest follow-up period reported to date.

Methods This study examined patients treated with ERAT for appendicitis across 21 centers in China from 2013 to 2023. Individuals with confirmed diagnoses via symptoms, lab tests, and imaging were enrolled. Appendicitis in the study was classified as uncomplicated, complicated, or absent based on procedure results. The intraoperative indicators included intubation guidance, use of a transparent cap, intubation success rate, appendix condition, and procedural time. Primary outcomes focused on the effectiveness and safety of ERAT, assessing technical success, symptomatic relief, and adverse events like perforation and complications. Secondary outcomes examined recurrence rates prompting medical intervention.

Results A total of 2,838 patients underwent ERAT for appendicitis, with an average age of 28.4 years; 52.5% were male. A history of appendicitis was noted in 96.1% of patients, with 83.3% experiencing an episode within two weeks and 17.7% receiving antibiotic treatment. 83.9% had acute appendicitis, while 16.1% had chronic appendicitis. In AA patients, 80.1% were classified as uncomplicated, 1.5% as perforated, and 2.3% as having a peri-appendiceal abscess. Preoperative imaging found appendicoliths in 38% of patients. The ERAT technical success rate was 97.5%, with a procedural time averaging 29.2 minutes. Procedures were guided by X-ray (55.8%), Cholangioscope (15.6%), and Abdominal Ultrasound (13.9%), with most using a tapered (47.7%) or standard transparent cap (31.7%). Saline irrigation was performed in 89.4% of cases. Appendiceal stents were placed in 35.4% of patients, with a primary adverse event rate of 0.8%. Successful ERAT rates reached 86%; however, 2.5% failed due to mis-intubation and 11.5% due to symptomatic recurrence. The mean hospital stay was 2.9 days, with costs amounting to 1,173 USD. Significant postoperative laboratory reductions were observed in leukocyte and CRP levels. The adverse event rate led to reoperations in 1.4% of patients, with a 2.5% readmission rate due to infections, predominantly new appendicitis or peritonitis.

Conclusions ERAT is a safe and effective option for appendicitis, with short recovery times, minimal invasiveness, and fewer adverse events. Larger-scale, long-term multicenter trials are needed for further validation.

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Artikel online veröffentlicht:
27. März 2025