Endoscopic Retrograde Appendicitis Therapy: A Novel Therapeutic Approach for Acute Appendicitis in Hematologic Patients

Aims Appendicitis in hematological patients is a rare condition associated with a higher mortality rate. Once a patient presents with acute appendicitis, emergent abdominal surgery becomes necessary. Appendectomy is the standard treatment for appendicitis in hematological patients; however, it carries an increased risk of complications and impacts survival rates. Endoscopic Retrograde Appendicitis Therapy (ERAT) is a minimally invasive technique that relieves pressure in the appendiceal cavity, reduces inflammation, and effectively treats appendicitis. This study aims to investigate the therapeutic value of ERAT for acute appendicitis in hematological patients.

Methods The study included 24 hematological patients (11 male, 13 female) diagnosed with acute appendicitis between April 2019 and August 2023 across five medical centers. Diagnostic categories included 5 acute lymphoblastic leukemia (ALL), 4 acute myeloid leukemia (AML), 1 acute mixed leukemia, 1 hemolytic anemia, 6 iron deficiency anemia, 3 microcytic anemia, and 3 Mediterranean anemia patients. Initial absolute neutrophil count (ANC) was less than 1×10^9/L in 10 patients; initial hemoglobin (Hb) levels were below 8.0 g/dL in 12 patients; and initial platelet (PLT) counts were less than 100×10^9/L in 8 patients. Imaging examinations showed appendiceal fecalith or inflammatory reactions. The time from symptom onset to diagnosis ranged from 1 to 4 days. All patients underwent ERAT, while those with complicated appendicitis, such as perforation or acute gangrene, were excluded from the study.

Results The technical success rate of the ERAT procedure was 100%. The average operation time was 42.0±23.1 minutes. All patients experienced immediate relief of abdominal pain, and rebound tenderness disappeared within 12 hours post-procedure. No complications occurred either during or after the procedure. Patients were routinely administered antibiotics and discharged after an average of 2.6±0.7 days. One patient succumbed to a lung infection three months following the procedure; however, there were no recurrences or other adverse events reported in the remaining patients during the 4 to 52-month follow-up period.

Conclusions ERAT offers a viable alternative treatment for appendicitis in hematological patients. Further studies with larger sample sizes are warranted to establish definitive conclusions regarding its efficacy and safety.

Publication History

Article published online:
27 March 2025