Abstract:

Objective To investigate the clinical efficacy and application value of biliary endoscopy-assisted endoscopic retrograde appendicitis therapy (ERAT) in the minimally invasive treatment of acute and chronic appendicitis. Methods A retrospective analysis was performed on the clinical data of 27 patients with acute or chronic appendicitis who underwent biliary endoscopy-assisted ERAT in the Department of Gastroenterology, the Affiliated Fuding Hospital of Fujian University of Traditional Chinese Medicine from April 2024 to December 2025. Colonoscopic and biliary endoscopic findings, procedure-related indicators, and postoperative recovery were recorded. Patients were followed up after surgery, and the recurrence rate and treatment satisfaction rate were calculated. Results Among the 27 patients, 7 had acute appendicitis and 20 had chronic appendicitis. The biliary endoscope insertion success rate was 100%, including 18 cases of direct insertion (66.7%) and 9 cases of guidewire-assisted insertion (33.3%). The procedure time was 19 (14, 28) min, and no complications such as bleeding or perforation occurred during the operation. Colonoscopy showed hyperemia and edema of the appendiceal orifice in 16 cases (59.3%), purulent discharge in 5 cases (18.5%), submucosal protrusion-like changes at the appendiceal orifice in 4 cases (14.8%), and fecalith impaction in 1 case (3.7%). Under biliary endoscopy, hyperemia and edema of the appendiceal mucosa were observed in 23 cases (85.2%), fecaliths/fecal debris in 16 cases (59.3%), and pus/flocculent material in 11 cases (40.7%). At 6 h after surgery, all patients had a visual analogue scale score <3, with a 100% symptom and sign relief rate. The mean hospital stay was (5.11±1.83) d. After a median follow-up of 12 months, the recurrence rate was 0 and the treatment satisfaction rate was 100%. In the 4 patients with appendiceal stents placed, all stents spontaneously detached 1 month after surgery. Pathology of 1 patient who underwent mucosal biopsy suggested hyperplastic polyp. In addition, 3 patients with negative preoperative abdominal CT findings were definitively diagnosed and successfully treated with this technique. Conclusion Biliary endoscopy-assisted ERAT is safe and effective for nonperforated, nongangrenous acute and chronic appendicitis. It offers a high insertion success rate, rapid postoperative recovery, and a low recurrence rate, while also providing diagnostic value for differential diagnosis. It may serve as a reference for clinical decision-making in appendicitis treatment.

Key words: appendicitis, biliary endoscopy, endoscopic retrograde appendicitis therapy (ERAT), efficacy, value