Abstract:

Objective To explore the clinical efficacy of endoscopic retrograde appendicitis therapy (ERAT) of acute uncomplicated appendicitis (AUA). Methods AUA patients hospitalized in the Hebei Medical University Third Hospital from January 2022 to January 2024 were selected for the study. Informed consent was obtained via telephone follow-up. Patients were divided into three groups according to their treatment modality: ERAT group (n=26), laparoscopic appendectomy (LA) group (n=63), and non-operative management (NOM) group (n=37). Inflammatory marker levels, length of hospitalization and costs, incidence of complications, and recurrence rates were compared among the three groups. Results The initial cure rate and incidence of adverse events were comparable across all three treatment methods, and all surgical methods could effectively alleviate pain. Both the white blood cell count (WBC) and neutrophil count (NEUT) decreased significantly (P<0.05). On day 1 post-treatment, interleukin-6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP) in the LA group were significantly higher than the ERAT and NOM groups (P<0.05), while D-dimer was comparable. Patients in the ERAT group had significantly shorter duration of off-bed activities than the LA group (P<0.01). Compared with NOM group, patients in the ERAT group had significantly shorter duration of first temperature drop and length of stay (P<0.05). Cost of hospitalization was the highest in LA group, followed by ERAT and NOM groups (P<0.05). The highest recurrent rate was seen in the NOM group, followed by ERAT and LA groups. Obesity, preservation of the appendix and presence of appendiceal fecal stones were independent risk factors for the recurrence of AUA (P<0.05). Conclusion ERAT, as a minimally invasive treatment option, demonstrates significant clinical value in the management of AUA, offering unique advantages over LA and NOM.

Key words: appendicitis, endoscopic retrograde appendicitis therapy, laparoscopic appendectomy, non-operative management