Z Gastroenterol 2018; 56(08): 899-904
DOI: 10.1055/a-0581-9119
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic retrograde appendicitis techniques for the treatment of patients with acute appendicitis

Endoskopische retrograde Appendizitistechniken zur Diagnose und Behandlung von Patienten mit akuter Appendizitis
Li-Ping Ye
1   Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang Province, China
,
Xin-Li Mao
1   Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang Province, China
,
Hai Yang
2   Department of Radiology, Enze Hospital, Wenzhou Medical University, Taizhou City, Zhejiang Province, China
,
Bi-Li He
1   Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang Province, China
,
Lin-Hong Zhu
3   Department of Medical Administration, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China
,
Yu Zhang
1   Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang Province, China
› Author Affiliations
Further Information

Publication History

13 October 2017

16 February 2018

Publication Date:
13 August 2018 (online)

Abstract

Objective The purpose of this study was to demonstrate the feasibility of endoscopic retrograde appendicitis therapy (ERAT) in treating patients with acute appendicitis.

Materials and methods Between January 2014 and December 2014, 22 patients with acute appendicitis underwent ERAT. Patient demographics, colonoscopy findings, endoscopic retrograde appendiceal radiography (ERAR) findings, and treatment outcomes of the ERAT and adverse events associated with ERAT were analyzed.

Results In this study, 22 patients with acute appendicitis underwent ERAT. The median age of the patients was 39.5 years. Colonoscopy findings included mucosal hyperemia and swelling of the appendiceal orifice and/or its surrounding mucosa (86.4 %, 19/22) and pus at the appendiceal orifice (40.9 %, 9/22). ERAR findings included irregular contour (76.2 %, 16/21), appendiceal lumen dilation (28.6 %, 6/21), appendiceal lumen stenosis (42.9 %, 9/21), and filling defect of the appendiceal lumen (23.8 %, 5/21). Deep intubation was successfully performed in 21 of the 22 patients (95.5 %). Sixteen patients underwent endoscopic appendiceal stent placement after endoscopic appendiceal irrigation (EAI) due to lumen stenosis of the appendiceal, excessive pus, or appendiceal fecalith, and the remaining 6 patients only underwent EAI. Among the 22 patients who underwent ERAT, their abdominal pain was noticeably relieved following the procedure. The main adverse events associated with ERAT were spontaneous discharge of the stent, recurrent abdominal pain, and recurrent appendicitis. During the follow-up (median 33 months), 2 patients underwent laparoscopic appendectomy.

Conclusions ERAT provide a new alternative therapeutic method for patients with acute appendicitis, particularly for certain patients who are unwilling to undergo an appendectomy.

Zusammenfassung

Ziel Nachweis, dass endoskopische retrograde Appendizitistechniken (ERATs) zur Behandlung von Patienten mit akuter Appendizitis geeignet sind.

Material und Methoden Zwischen Januar 2014 und Dezember 2014 wurden 22 Patienten mit akuter Appendizitis mittels ERAT untersucht und behandelt. Die demografischen Daten der Patienten, Ergebnisse der Koloskopie, der endoskopisch retrograden Appendikografie (ERAR) und Behandlungsergebnisse der ERAT sowie unerwünschte Ereignisse im Zusammenhang mit ERAT wurden analysiert.

Ergebnisse In dieser Studie wurden 22 Patienten mit akuter Appendizitis mittels ERAT untersucht und behandelt. Das Durchschnittsalter der Patienten betrug 39,5 Jahre. Ergebnisse der Koloskopie waren muköse Hyperämie und Schwellung des Appendixostiums und/oder des umgebenden Gewebes (86,4 %; 19/22), sowie Eiter am Appendixostium (40,9 %; 9/22). Die endoskopische retrograde Appendikografie zeigte unregelmäßige Konturen (76,2 %; 16/21), Dilatation des Appendixlumens (28,6 %; 6/21), Stenose des Appendixlumens (42,9 %; 9/21), sowie Kontrastmittelaussparung des Appendixlumens (23,8 %; 5/21). Bei 21 von 22 Patienten wurde erfolgreich eine Intubationsnarkose durchgeführt (95,5 %). Bei 16 Patienten wurde aufgrund einer Stenose des Appendixlumens, exzessivem Eiter oder Kotstein nach endoskopischer Appendixspülung (EAI) endoskopisch ein Appendixstent eingesetzt (ERSP); die verbleibenden sechs Patienten erhielten lediglich EAI. Bei den 22 Patienten, die mittels ERAT behandelt wurden, waren die Unterbauchschmerzen nach dem Verfahren deutlich gelindert. Die wichtigsten unerwünschten Ereignisse durch ERAT waren spontaner Ausfluss aus dem Stent, wiederkehrende Bauchschmerzen und rezidivierende Appendizitis. Während des Follow-ups (durchschnittlich 33 Monate), wurde bei zwei Patienten eine laparoskopische Appendektomie durchgeführt.

Schlussfolgerungen ERATs bieten neue alternative Therapiemethoden für Patienten mit akuter Appendizitis, insbesondere für Patienten, die eine Appendektomie ablehnen.

 
  • References

  • 1 Leung YK, Chan CP, Graham CA. et al. Acute appendicitis in adults: diagnostic accuracy of emergency doctors in a university hospital in Hong Kong. Emerg Med Australas 2017; 29: 48-55
  • 2 Lee JH, Park YS, Choi JS. The epidemiology of appendicitis and appendectomy in South Korea: national registry data. J Epidemiol 2010; 20: 97-105
  • 3 Kilincer A, Akpinar E, Erbil B. et al. A new technique for the diagnosis of acute appendicitis: abdominal CT with compression to the right lower quadrant. Eur Radiol 2017; 27: 3317-3325
  • 4 Favot MJ, Ehrman RR. What elements of the history, examination, laboratory testing, or point-of-care ultrasonography are most useful in the diagnosis of acute appendicitis in children?. Ann Emerg Med 2017; 70: 797-798
  • 5 Mock K, Lu Y, Friedlander S. et al. Misdiagnosing adult appendicitis: clinical, cost, and socioeconomic implications of negative appendectomy. Am J Surg 2016; 212: 1076-1082
  • 6 Galai T, Beloosesky OZ, Scolnik D. et al. Misdiagnosis of acute appendicitis in children attending the emergency department: the experience of a large, tertiary care pediatric hospital. Eur J Pediatr Surg 2017; 27: 138-141
  • 7 Liu CH, Tsai FC, Hsu SJ. et al. Successful colonoscopic drainage of appendiceal pus in acute appendicitis. Gastrointest Endosc 2006; 64: 1011
  • 8 Liu BR, Song JT, Han FY. et al. Endoscopic retrograde appendicitis therapy: a pilot minimally invasive technique (with videos). Gastrointest Endosc 2012; 76: 862-866
  • 9 Li Y, Mi C, Li W. et al. Diagnosis of acute appendicitis by endoscopic retrograde appendicitis therapy (ERAT): combination of colonoscopy and endoscopic retrograde appendicography. Dig Dis Sci 2016; 61: 3285-3291
  • 10 Giljaca V, Nadarevic T, Poropat G. et al. Diagnostic accuracy of abdominal ultrasound for diagnosis of acute appendicitis: systematic review and meta-analysis. World J Surg 2017; 41: 693-700
  • 11 Atema JJ, Gans SL, Van Randen A. et al. Comparison of imaging strategies with conditional versus immediate contrast-enhanced computed tomography in patients with clinical suspicion of acute appendicitis. Eur Radiol 2015; 25: 2445-2452
  • 12 Liu BR, Ma X, Feng J. et al. Endoscopic retrograde appendicitis therapy (ERAT): a multicenter retrospective study in China. Surg Endosc 2015; 29: 905-909
  • 13 Randal Bollinger R, Barbas AS, Bush EL. et al. Biofilms in the large bowel suggest an apparent function of the human vermiform appendix. J Theor Biol 2007; 249: 826-831
  • 14 Laurin M, Everett ML, Parker W. The cecal appendix: one more immune component with a function disturbed by post-industrial culture. Anat Rec (Hoboken) 2011; 294: 567-579
  • 15 Lundholm K, Hansson-Assarsson J, Engstrom C. et al. Long-term results following antibiotic treatment of acute appendicitis in adults. World J Surg 2017; 41: 2245-2250
  • 16 Vons C, Barry C, Maitre S. et al. Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, randomised controlled trial. Lancet 2011; 377: 1573-1579