Appendoscope-Assisted Endoscopic Retrograde Appendicitis Therapy Versus Antibiotic Monotherapy for Acute Uncomplicated Appendicitis.

Background

AND

Aims

This is a single-center retrospective study aiming to compare the clinical efficacy and safety of appendoscope-assisted endoscopic retrograde appendicitis therapy (ERAT) versus antibiotic monotherapy in patients with acute uncomplicated appendicitis (AUA).

Methods

We retrospectively enrolled patients diagnosed with AUA who received appendoscope-assisted ERAT or antibiotic monotherapy between July 2023 and August 2024. After exclusion and propensity score matching (PSM, 1:1), 40 matched patient pairs were included in the final analysis. The primary outcome was treatment failure within one year, defined as a composite of initial treatment failure and 1-year appendicitis recurrence. Secondary outcomes included time to abdominal pain relief, duration of antibiotic therapy, length of hospital stay, hospitalization costs, and the incidence of disease- or procedure-related adverse events.

Results

Compared with antibiotic monotherapy, ERAT was associated with a significantly lower incidence of treatment failure within one year (12.5% [5/40] vs. 42.5% [17/40]; P = 0.003) and a lower 1-year appendicitis recurrence rate (10.3% [4/39] vs. 30.3% [10/33]; P = 0.032). Although the initial treatment failure rate was lower in the ERAT group than in the antibiotic monotherapy group, the difference did not reach statistical significance (2.5% [1/40] vs. 17.5% [7/40]; P = 0.057). Additionally, ERAT significantly shortened the time to abdominal pain relief (6.0 vs. 48.0 h; P < 0.001), the duration of antibiotic therapy (2.0 vs. 5.0 days; P < 0.001), and the length of hospital stay (1.0 vs. 5.0 days; P < 0.001). However, hospitalization costs were higher in the ERAT group (10,408.6 vs. 2,868.9 CNY; P < 0.001). No disease- or procedure-related adverse events occurred in either group.

Conclusion

Appendoscope-assisted ERAT appears to offer a safe and effective alternative for patients with AUA who wish to avoid appendectomy. Further large-scale, multicenter prospective studies are warranted to validate its long-term efficacy and establish its future clinical application.