Aims
This study compared the outcomes of endoscopic retrograde appendiceal irrigation (ERAI) and endoscopic retrograde appendicitis therapy (ERAT) in patients with acute uncomplicated appendicitis.
Methods
We conducted a multicenter retrospective study of patients who received ERAI or ERAT for acute uncomplicated appendicitis between May 2020 and May 2023. After applying 1 to 1 propensity score matching, we evaluated technical and clinical success as the main outcomes. We also compared procedure time, hospital stay, treatment costs, postoperative recovery, adverse events, and long-term recurrence.
Results
A total of 725 patients were included, and 179 matched pairs were analyzed. Baseline characteristics were comparable between groups. Technical and clinical success rates were similar for ERAI and ERAT (93.9% vs 97.2%; 93.5% vs 96.6%; p = 0.907 and 0.833, respectively). ERAI resulted in shorter procedure time and postoperative hospitalization, and lower total cost. Postoperative pain relief, normalization of inflammatory markers, and short- and long-term adverse event rates did not differ between groups. Cumulative recurrence rates at 1, 3, and 5 years were higher in the ERAI group (8.3%, 12.0%, 17.6%) than in the ERAT group (4.0%, 6.9%, 11.8%).
|
Outcomes and adverse events |
ERAI (n = 168) |
ERAT (n = 174) |
p |
|
Procedure time, mean (SD), min |
15.0 (2.5) |
27.2 (9.1) |
< 0.001 |
|
Fecalith expulsion during procedure, n (%) |
80 (47.6) |
106 (60.9) |
0.179 |
|
Appendiceal stent placement, n (%) |
17 (10.1) |
67 (38.5) |
< 0.001 |
|
VAS for pain ≤ 3 at 6 h after treatment, n (%) |
153 (91.1) |
160 (92.0) |
0.950 |
|
Normal laboratory test results1, n (%) |
150 (89.3) |
115 (79.3) |
0.067 |
|
Postoperative length of hospital stay, mean (SD), days |
1.5 (0.8) |
2.0 (1.8) |
0.004 |
|
Hospital cost, mean (SD), RMB |
6,468.7 (3087.5) |
11,510.4 (5906.8) |
< 0.001 |
|
Clinical success rate2, n (%) |
157 (93.5) |
168 (96.6) |
0.833 |
|
Overall adverse event rate, n (%) |
35 (20.8) |
22 (12.6) |
0.086 |
|
Follow-up duration, median (IQR), months |
48 (38–57) |
49 (38–53) |
0.702 |
|
Recurrence of appendicitis, n (%) |
26 (15.5) |
15 (8.6) |
0.084 |
|
Time to recurrence, median (IQR), months |
13 (3–35) |
16 (7–29) |
0.694 |
|
Overall short-term adverse event rate3, n (%) |
10 (6.0) |
7 (4.0) |
0.435 |
|
Fever4 |
6 (3.6) |
4 (2.2) |
0.498 |
|
Appendiceal perforation |
4 (2.0) |
3 (1.7) |
0.674 |
|
Overall long-term adverse event rate5, n (%) |
25 (14.9) |
15 (8.6) |
0.109 |
|
Abdominal pain |
5 (3.0) |
2 (1.1) |
0.243 |
|
Diarrhea6 |
1 (0.6) |
2 (1.1) |
0.586 |
|
Constipation |
0 (0.0) |
1 (0.6) |
0.327 |
Conclusions
ERAI achieved similar technical and clinical results as ERAT while offering shorter procedures, faster recovery, and lower costs. Although recurrence was somewhat higher after ERAI, most patients were successfully treated with repeat endoscopic therapy or conservative care. ERAI may be a practical and affordable option for patients with uncomplicated appendicitis, especially in settings where ERAT is less accessible