Endoscopic Retrograde Appendicitis Therapy (ERAT): A New Endoscopic Technique From China

Abstract

SymbolIntroduction: Inspired by the success of ERCP for the treatment of suppurative cholangitis, we investigated a new minimally invasive method for the treatment of acute uncomplicated appendicitis, which we call endoscopic retrograde appendicitis therapy. The aim of the study is to review the clinical outcomes of ERAT and further examine its effectiveness and safety.SymbolMethods: The study was performed of consecutive patients who underwent ERAT for acute uncomplicated appendicitis in China from December 2009 to May 2013. There were 5 steps after insertion of a colonoscope into the cecum and identification of the appendiceal orifice: (1) endoscopic appendiceal cannulation; (2) appendiceal decompression; (3) retrograde appendicography; (4) cleansing the appendiceal lumen; (5) stent drainage; and (6) extraction of intraluminal fecaliths if possible. Results: Forty-one patients were entered among which 34 patients were definitely diagnosed as acute uncomplicated appendicitis; in 7 patients acute appendicitis was excluded by endoscopic retrograde appendicography. Thirty-three patients completed ERAT except one patient who failed appendiceal cannulation. Abdominal pain resolved immediately in 32 patients and clinical success rate was 97% (Table 1). There was one failure case (3%) that complicated perforation after 48 hours received emergency appendectomy. The median follow-up period was 12 months (IQR=9-23 months). During follow-up there were no long-term complications; 2 patients (6.2%) had recurrent abdominal pain and received appendectomy (one had a histologically normal appendix) (Table 2).Table 1: Outcomes of ERATTable 2: Clinical OutcomesConclusion: ERAT is an effective method to diagnose and treat acute uncomplicated appendicitis. Multicenter prospective clinical trials are needed to confirm its utility and place in management of suspected acute appendicitis.