Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(07): E1014-E1019
DOI: 10.1055/a-1819-8231
Original article

Endoscopic retrograde appendicitis therapy for acute appendicitis: a systematic review and meta-analysis

Banreet Dhindsa
1   University of Nebraska Medical Center, Gastroenterology and Hepatology, Omaha, Nebraska, United States
,
Yassin Naga
2   University of Nevada School Medicine, Internal Medicine, Las Vegas, Nevada, United States
,
Alexander Praus
3   University of Nebraska Medical Center, Department of Internal Medicine, Omaha, Nebraska, United States
,
Syed Mohsin Saghir
4   Creighton University School of Medicine, Division of Gastroenterology and Hepatology, Omaha, Nebraska, United States
,
Harmeet Mashiana
1   University of Nebraska Medical Center, Gastroenterology and Hepatology, Omaha, Nebraska, United States
,
Daryl Ramai
5   University of Utah School of Medicine, Gastroenterology and Hepatology, Salt Lake City, Utah, United States
,
Saurabh Chandan
4   Creighton University School of Medicine, Division of Gastroenterology and Hepatology, Omaha, Nebraska, United States
,
Harlan Sayles
6   University of Nebraska Medical Center, Biostatistics, Omaha, Nebraska, United States
,
Amaninder Dhaliwal
7   McLeod Health, Division of Gastroenterology, Florence, South Carolina, United States
,
Ishfaq Bhat
1   University of Nebraska Medical Center, Gastroenterology and Hepatology, Omaha, Nebraska, United States
,
Shailender Singh
1   University of Nebraska Medical Center, Gastroenterology and Hepatology, Omaha, Nebraska, United States
,
Douglas Adler
8   Centura Health, Center for Advanced Therapeutic Endoscopy, Englewood, Colorado, United States
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and study aims Endoscopic retrograde appendicitis therapy (ERAT) is an endoscopic procedure for management of patients with acute appendicitis (AA). In addition to being minimally invasive, it has the added advantages of preservation of appendix and simultaneous inspection of colon. We performed a systematic review and meta-analysis on ERAT in patients with AA.

Methods We conducted a comprehensive search of multiple electronic databases (from inception through January 2022) to identify studies reporting ERAT in AA. The primary outcome was to evaluate the overall clinical and technical success of ERAT. The secondary outcome was to study the total and individual adverse events (AEs). The meta-analysis was performed using Der Simonian and Laird random effect model.

Results Seven studies reporting on 298 patients were included. The majority of the patient population was male (55.3 %), with mean age of 31 ± 12.39 years. The pooled technical success rate was 99.36 % (95 % CI 97.61–100, I2 = 0) and the pooled clinical success rate was 99.29 % (95 % CI 97.48–100, I2 = 0). The pooled AE rate was 0.19 % (95 % CI 0–1.55, I2 = 0). The most common AE was perforation with 0.19 % (95 % CI 0–1.55, I2 = 0). The recurrence rate was 6.01 % (95 % CI 2.9–9.93, I2 = 20.10). Average length of procedure was 41.1 ± 7.16 min. Low heterogeneity was noted in in our meta-analysis.

Conclusions ERAT is a safe procedure with high rates of clinical and technical success in patients with AA. Further randomized controlled trials should be performed to assess the utility of ERAT in AA as compared to laparoscopic appendectomy.

Supplementary material



Publication History

Received: 06 December 2021

Accepted after revision: 06 April 2022

Accepted Manuscript online:
07 April 2022

Article published online:
15 July 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Hardin Jr. DM. Acute appendicitis: review and update. Am Fam Physician 1999; 60: 2027-2034
    PubMedGoogle Scholar
  • 2 Jones MW, Lopez RA, Deppen JG. et al. Appendicitis (Nursing). Treasure Island (FL): StatPearls; 2021
    Google Scholar
  • 3 Soffer D, Zait S, Klausner J. et al. Peritoneal cultures and antibiotic treatment in patients with perforated appendicitis. Eur J Surg 2001; 167: 214-216
    CrossrefPubMedGoogle Scholar
  • 4 Jaschinski T, Mosch C, Eikermann M. et al. Laparoscopic versus open appendectomy in patients with suspected appendicitis: a systematic review of meta-analyses of randomised controlled trials. BMC Gastroenterol 2015; 15: 48
    CrossrefPubMedGoogle Scholar
  • 5 Flum DR, Davidson GH. CODA Collaborative. et al. A randomized trial comparing antibiotics with appendectomy for appendicitis. N Engl J Med 2020; 383: 1907-1919
    CrossrefPubMedGoogle Scholar
  • 6 Salminen P, Paajanen H, Rautio T. et al. Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis: The APPAC Randomized Clinical Trial. JAMA 2015; 313: 2340-2348
    Google Scholar
  • 7 Salminen P, Tuominen R, Paajanen H. et al. Five-year follow-up of antibiotic therapy for uncomplicated acute appendicitis in the APPAC Randomized Clinical Trial. JAMA 2018; 320: 1259-1265
    CrossrefPubMedGoogle Scholar
  • 8 Seetahal SA, Bolorunduro OB, Sookdeo TC. et al. Negative appendectomy: a 10-year review of a nationally representative sample. Am J Surg 2011; 201: 433-437
    CrossrefPubMedGoogle Scholar
  • 9 Flum DR, Koepsell T. The clinical and economic correlates of misdiagnosed appendicitis: nationwide analysis. Arch Surg 2002; 137: 799-804
    PubMedGoogle Scholar
  • 10 Kang J, Zhang W, Zeng L. et al. The modified endoscopic retrograde appendicitis therapy versus antibiotic therapy alone for acute uncomplicated appendicitis in children. Surg Endosc 2021; 35: 6291-6299
    CrossrefPubMedGoogle Scholar
  • 11 Liu BR, Ma X, Feng J. et al. Endoscopic retrograde appendicitis therapy (ERAT) : a multicenter retrospective study in China. Surg Endosc 2015; 29: 905-909
    Google Scholar
  • 12 Liu BR, Song JT, Han FY. et al. Endoscopic retrograde appendicitis therapy: a pilot minimally invasive technique (with videos). Gastrointestinal endoscopy 2012; 76: 862-866
    CrossrefPubMedGoogle Scholar
  • 13 Moher D, Liberati A, Tetzlaff J. et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009; 151: 264-269 W264
    CrossrefPubMedGoogle Scholar
  • 14 Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010; 25: 603-605
    Google Scholar
  • 15 Higgins JP, Altman DG, Gotzsche PC. et al. The Cochrane Collaborationʼs tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928
    Google Scholar
  • 16 Ding W, Du Z, Zhou X. Endoscopic retrograde appendicitis therapy for mnagement of acute appendicitis. Surg Endosc 2022; 36: 2480-2487
    Google Scholar
  • 17 Li Y, Mi C, Li W. et al. Diagnosis of acute appendicitis by endoscopic retrograde appendicitis therapy (ERAT): Combination of Colonoscopy and endoscopic retrograde appendicography. Dig Dis Sci 2016; 61: 3285-3291
    CrossrefPubMedGoogle Scholar
  • 18 Ye LP, Mao XL, Yang H. et al. Endoscopic retrograde appendicitis techniques for the treatment of patients with acute appendicitis. Z Gastroenterol 2018; 56: 899-904
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Kong LJ, Liu D, Zhang JY. et al. Digital single-operator cholangioscope for endoscopic retrograde appendicitis therapy. Endoscopy 2022; 54: 396-400
    Google Scholar
  • 20 Chen Y, Wang X, Zhao L. et al. Mo1664 Endoscopic intervention for acute appendicitis: retrospective study of 101 cases. Gastrointest Endosc 2019; 89: AB511
    CrossrefPubMedGoogle Scholar
  • 21 DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177-188
    Google Scholar
  • 22 Sutton AJ, Abrams KR, Jones DR. et al. Methods for meta-analysis in medical research. Chichester: Wiley; 2000
    Google Scholar
  • 23 Higgins JP, Thompson SG, Deeks JJ. et al. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-560
    Google Scholar
  • 24 Kanwal F, White D. “Systematic reviews and meta-analyses” in clinical gastroenterology and hepatology. Clin Gastroenterol Hepatol 2012; 10: 1184-1186
    CrossrefPubMedGoogle Scholar
  • 25 Guyatt GH, Oxman AD, Kunz R. et al. GRADE guidelines: 7. Rating the quality of evidence--inconsistency. J Clin Epidemiol 2011; 64: 1294-1302
    CrossrefPubMedGoogle Scholar
  • 26 Ambe PC. Negative Appendectomy. Is it really preventable?. J Invest Surg 2019; 32: 474-475
    CrossrefPubMedGoogle Scholar
  • 27 Bhangu A, Soreide K, Di Saverio S. et al. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet 2015; 386: 1278-1287
    Google Scholar
  • 28 Jeon BG. Predictive factors and outcomes of negative appendectomy. Am J Surg 2017; 213: 731-738
    CrossrefPubMedGoogle Scholar
  • 29 Maloney C, Edelman MC, Bolognese AC. et al. The impact of pathological criteria on pediatric negative appendectomy rate. J Ped Surg 2019; 54: 1794-1799
    CrossrefPubMedGoogle Scholar