Endoscopic retrograde appendicitis therapy or antibiotics for uncomplicated appendicitis.

Abstract

Although laparoscopic appendectomy is the common intervention for uncomplicated acute appendicitis, there are risks1. Guidelines from the World Society of Emergency Surgery suggest that antibiotic therapy is an option2, but recurrence is 15 to 39 percent at 5 years3. A mini-invasive technique called endoscopic retrograde appendicitis treatment (ERAT) was developed for uncomplicated appendicitis instead of antibiotics or surgery4. ERAT aims to relieve the obstruction or stenosis of the appendiceal lumen, to prevent recurrent episodes of the disease (92 to 95 percent have not had a recurrence to date)5–7. This multicentre study assessed ERAT versus antibiotics for the treatment of uncomplicated appendicitis. Data on adult patients treated with ERAT or antibiotics for imaging-confirmed uncomplicated appendicitis from five centres in China (May 2018 to June 2020) was assessed retrospectively. The ERAT procedure was performed as described4 (Appendix S1). The antibiotic group received intravenous metronidazole 500 mg q8h combined with ceftriaxone 2 g q12h, cefoperazone/sulbactam 2 g q12h, or piperacillin–tazobactam 4.5 g q8h. Oral antibiotics (metronidazole 500 mg q8h with levofloxacin 500 mg q24h, ciprofloxacin 500 mg q8h, or amoxicillin–clavulanic acid 625 mg q8h) were taken after a minimum 72 hours of intravenous antibiotics. Patients could take analgesics as needed. Appendicectomy was recommended if there was worsening pain or white cell count.