Safety and Efficacy of Endoscopic Retrograde Appendicitis Therapy: A Systematic Review and Meta-Analysis

Introduction: Endoscopic Retrograde Appendicitis Therapy (ERAT) is an innovative endoscopic procedure for the management of patients with acute appendicitis. Benefits of this procedure include a minimally invasive approach with preservation of the appendix and an alternative in patients high risk for surgical intervention. This can also be considered a bridge to laparoscopic appendectomy in acutely ill patients. Its adoption in clinical practice is limited due to initial concerns for rates of recurrence of appendicitis. In this study, we perform a systematic review and meta-analysis to determine the safety and efficacy of utilizing ERAT for uncomplicated acute appendicitis. Methods: We conducted a comprehensive systemic literature review utilizing PubMed and Google Scholar for case series, prospective studies, and retrospective studies to analyze efficacy and safety of ERAT. Researchers independently extracted data including patient demographics, medical history, and the following ERAT data: success rate, total adverse events (perforation, bleeding, obstruction, infection), recurrence rate, procedure time, hospital length of stay, and costs. All data was reported as weighted averages. Results: A total of 10 studies involving 447 patients who underwent ERAT for uncomplicated acute appendicitis were included in our analysis (Figure 1). All the studies identified in our analysis were conducted in China. The average age of all patients was 34.3 years old; 47.4% were female. The average success rate of ERAT was 99%. In terms of adverse events, there were 3 cases of perforation, 0 cases of bleeding/obstruction, and 0 cases of infection. The rate of recurrence was 8.72% (39/447 total cases). The average length of stay was 3.4 days and average cost reported in 2 studies was approximately 8.264.5 Chinese Yuan (1,162.41 USD) per procedure. Conclusion: This is the most recent systematic review and meta-analysis of ERAT performed to-date. Our study demonstrates that ERAT is an efficient and innovate technology that confers impressive success rates without significant rates major complications. Further studies including further cost analysis, larger population samples, and implementation in other countries are needed to strengthen this analysis and lead to the widespread adoption of ERAT technique among interventional gastroenterologists.Figure 1.: Study subjects.