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. 2021 Nov 26;9(33):10208-10221.
doi: 10.12998/wjcc.v9.i33.10208.

Is endoscopic retrograde appendicitis therapy a better modality for acute uncomplicated appendicitis? A systematic review and meta-analysis

Ying Wang  1 , Chen-Yu Sun  2 , Jie Liu  3 , Yue Chen  4 , Chandur Bhan  2 , John Pocholo Whitaker Tuason  2 , Sudha Misra  2 , Yu-Ting Huang  5 , Shao-Di Ma  6 , Xing-Yu Cheng  4 , Qin Zhou  7 , Wen-Chao Gu  8 , Dan-Dan Wu  9 , Xia Chen  10
Affiliations

Is endoscopic retrograde appendicitis therapy a better modality for acute uncomplicated appendicitis? A systematic review and meta-analysis

Ying Wang et al. World J Clin Cases. .

Abstract

Background: Previous studies had shown endoscopic retrograde appendicitis therapy (ERAT) is an effective treatment for acute appendicitis. However, different studies reported conflicting outcomes regarding the effectiveness of ERAT in comparison with laparoscopic appendectomy (LA).

Aim: To compare the effectiveness of ERAT with LA.

Methods: Randomized controlled trials (RCTs) and retrospective studies of ERAT for acute uncomplicated appendicitis were searched in PubMed, Cochrane Library, Web of Science, Embase database, China National Knowledge Infrastructure (CNKI), the WanFang Database, and Chinese Scientific Journals Database (VIP) from the establishment date to March 1 2021. Heterogeneity was assessed using the I-squared statistic. Pooled odds ratios (OR), weighted mean difference (WMD), and standard mean difference (SMD), with 95% confidence intervals (CI) were calculated through either fixed-effects or random-effects model. Sensitivity analysis was also performed. Publication bias was tested by Egger's test, and Begg's test. The quality of included RCT were evaluated by the Jadad scale, while Newcastle-Ottawa scale is adopted for assessing the methodological quality of case-control studies. All statistical analysis was performed using Stata 15.1 statistical software. All statistical analysis was performed using Stata 15.1 statistical software. This study is registered with PROSPERO, CRD42021243955.

Results: After screening, 10 RCTs and 2 case-control studies were included in the current systematic review. Firstly, the length of hospitalizations [WMD = -1.15, 95%CI: -1.99, -0.31; P = 0.007] was shorter than LA group. Secondly, the level of post-operative CRP [WMD = -10.06, 95%CI: (-17.39, -2.73); P = 0.007], TNF-α [WMD = -7.70, 95%CI: (-8.47, -6.93); P < 0.001], and IL-6 Levels [WMD = -9.78, 95%CI: (-10.69, -8.88); P < 0.001; P < 0.001] in ERAT group was significantly lower than LA group. Thirdly, ERAT group had a lower incidence of intestinal obstruction than LA group. [OR = 0.19, 95%CI: (0.05, 0.79); P = 0.020]. Moreover, the quality of 10 RCTs were low with 0-3 Jadad scores, while the methodological quality of two case-control studies were fair with a score of 2 (each).

Conclusion: Compared with LA, ERAT reduces operation time, the level of postoperative inflammation, and results in fewer complications and shorter recovery time, with preserving the appendix and its immune and biological functions.

Keywords: Acute appendicitis; Endoscopic retrograde appendicitis therapy; Laparoscopic appendectomy; Meta analysis; Randomized controlled study.

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Conflict of interest statement

Conflict-of-interest statement: Allauthors have no conflict(s) of interest to declare in relation to this manuscript.

Figures

Figure 1
Figure 1
Flow diagram representing the selection of studies.
Figure 2
Figure 2
Forest plot of bed rest time.
Figure 3
Figure 3
Forest plot of time interval of body temperature returning to normal range.
Figure 4
Figure 4
Forest plot of time interval of white blood cell count returning to normal range.
Figure 5
Figure 5
Forest plot of duration of operation.
Figure 6
Figure 6
Forest plot of length of hospitalizations.
See this image and copyright information in PMC

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