Endoscopic retrograde appendicitis therapy: a pilot minimally invasive technique (with videos)

Abstract

Background: Inspired by the success of ERCP for the treatment of suppurative cholangitis, we investigated a new minimally invasive method for the treatment of acute uncomplicated appendicitis, which we call endoscopic retrograde appendicitis therapy.

Objective: To investigate the feasibility and efficacy of endoscopic retrograde appendicitis therapy for the treatment of acute uncomplicated appendicitis.

Design and setting: A retrospective, single-center study at an academic medical center.

Patients: Four patients with acute uncomplicated appendicitis.

Interventions: There were 5 steps after insertion of a colonoscope into the cecum and identification of the appendiceal orifice: (1) endoscopic appendiceal intubation; (2) appendiceal decompression; (3) retrograde appendicography; (4) stent drainage; and (5) cleansing the appendiceal lumen.

Main outcome measurements: The rate of successful endoscopic intubation and decompression, the time to symptom relief, the time to disappearance of signs, increased white blood cell count, procedure-related complications, and recurrence, if any.

Results: All 4 endoscopic appendiceal intubations were successful. Pain was relieved immediately after endoscopic decompression and stent drainage. Leukocytosis returned to normal within 24 hours. There were no complications and no recurrences during 4 to 19 months of follow-up.

Limitations: Small sample size, single-center study without controls.

Conclusion: Endoscopic retrograde appendicitis therapy is a feasible and effective endoscopic treatment modality for acute uncomplicated appendicitis.