Abstract
Background and AimsEndoscopic retrograde appendicitis therapy (ERAT) has emerged as a minimally-invasive, endoscopic alternative to laparoscopic appendectomy in the treatment of acute appendicitis. This systematic review and meta-analysis aims to evaluate the efficacy and safety of ERAT in treating uncomplicated, acute appendicitis. MethodsA systematic review of studies in the PubMed/MEDLINE and Cochrane databases was performed through June 2023. The primary outcomes included clinical success rate (defined as resolution in signs and symptoms of appendicitis) and technical success rate (defined as successful placement of a drain or stent within the appendiceal orifice or irrigation to relieve appendiceal obstruction). Secondary outcomes included adverse event rates and rates of intestinal perforation, procedure time, hospital length of stay, duration of follow up, and rates of appendicitis recurrence after ERAT. ResultsA total of eight studies were considered eligible for analysis (326 patients; average age 36.4 years old, 55.4% male). The rate of technical success was 98% (95% CI; 97%, 100%; I2=2.2%), and the rate of clinical success was 99% (95% CI; 97%, 100%; I2=0%). The total pooled adverse event rate was 1.8% (95% CI; 0.4%, 3.2%, I2=0%) with a pooled intestinal perforation rate of 1.5% (95% CI; 0.02%, 2.8%, I2=0%). The average procedure time was 44.9 minutes. The average hospital length of stay following ERAT was 3.22 days. The aggregate rate of appendicitis recurrence following ERAT was 6% (95% CI; 3%, 9%; I2=16.5%) after being followed for an average of 17.7 months. ConclusionsERAT demonstrates excellent technical and clinical success rates with minimal adverse events. Additional randomized controlled studies are needed to refine inclusion criteria and to standardize the approach to appendiceal stent placement during ERAT to minimize rates of intestinal perforation.
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