Reduced recurrence rate with a targeted approach in uncomplicated appendicitis treated with endoscopic direct vs retrograde therapy.

BACKGROUND

Endoscopic retrograde appendicitis therapy (ERAT) offers an appendix-preserving approach; however, visual and specificity challenges persist. Conversely, endoscopic direct appendicitis therapy (EDAT) provides direct visual observation with diagnostic and therapeutic capabilities.

AIM: To assess the efficacy and feasibility of EDAT and compare them with those of ERAT in uncomplicated appendicitis.

METHODS

In this retrospective cohort study, patients diagnosed with uncomplicated appendicitis and treated with ERAT or EDAT between January 2021 and November 2024 were reviewed. The primary outcome was intervention success. Secondary outcomes were guidewire use, stent placement, hospitalization duration, recurrence, and endoscopic direct-view features. Outcomes were compared between groups via appropriate statistical tests.

RESULTS

Of 170 patients, 136 underwent EDAT and 34 ERAT. EDAT showed higher intervention success than ERAT (99.3% vs 82.4%, P < 0.001), with less guidewire assistance and fewer stent placements (both P < 0.001). Hospital stay was shorter with EDAT (P = 0.039). The overall cumulative recurrence rates at 1 year were 10% in EDAT and 24% in ERAT; in the appendicolith subgroup, the recurrence rates were 5% and 14% in EDAT and ERAT, respectively. Findings were consistent in the propensity score-matched (PSM) cohort.

CONCLUSION

EDAT was demonstrated to be a more effective and feasible approach than ERAT, with a lower overall cumulative recurrence risk and within the appendicolith subgroup. Consistent results after PSM further supported the robustness of these findings.