Abstract

BackgroundAn increasing number of studies have shown the merits of endoscopic retrograde appendicitis therapy (ERAT) in diagnosing and treating acute uncomplicated appendicitis. However, no related prospective controlled studies have been reported yet. Our aim is to assess the feasibility and safety of ERAT in the treatment of acute uncomplicated appendicitis.MethodsIn this open-label, randomized trial, participants were randomly allocated to the ERAT group, laparoscopic appendectomy (LA) group and open appendectomy (OA) group. The primary outcome was the clinical success rate of the treatment. Intention-to-treat analysis was used in the study.ResultsThe study comprised of 99 patients, with 33 participants in each group. The clinical success rate was 87.88% (29/33), 96.97% (32/33) and 100% (33/33) in the ERAT, LA and OA group, respectively. In the ERAT group, 4 patients failed ERAT due to difficult cannulation. In LA group, 1 patient failed because of abdominal adhesion. There were no significant differences among the three treatment groups regarding the clinical success rate (P = 0.123). The median duration of follow-up was 22 months. There were no significant differences (P = 0.693) among the three groups in terms of adverse events and the final crossover rate of ERAT to surgery was 21.21% (7/33).ConclusionERAT can serve as an alternative and efficient method to treat acute uncomplicated appendicitis.Trial registration The study is registered with the WHO Primary Registry-Chinese Clinical Trial Registry (ChiCTR1900025812).

Highlights

  • Acute appendicitis is one of the most common causes of acute abdominal pain clinically [1]

  • As previous studies suggested that perforation may not be an inevitable consequence of acute appendicitis, there is a division of opinions on performing surgery on patients with acute uncomplicated appendicitis [5]

  • Patients characteristics A total of 514 patients were assessed for eligibility, and 99 patients were enrolled in the study

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Summary

Introduction

Acute appendicitis is one of the most common causes of acute abdominal pain clinically [1]. Appendectomy has long been standard treatment for acute appendicitis. As previous studies suggested that perforation may not be an inevitable consequence of acute appendicitis, there is a division of opinions on performing surgery on patients with acute uncomplicated appendicitis [5]. Developing a safe and efficient nonoperative method has been an agenda for treating acute uncomplicated appendicitis. An increasing number of studies have shown the merits of endoscopic retrograde appendicitis therapy (ERAT) in diagnosing and treating acute uncomplicated appendicitis. No related prospective controlled studies have been reported yet. Our aim is to assess the feasibility and safety of ERAT in the treatment of acute uncomplicated appendicitis

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