Analysis of operative skills and effects of endoscopic retrograde appendicitis therapy

Objective: To study the skills and effects of endoscopic retrograde appendicitis therapy (ERAT) in treating patients with uncomplicated acute appendicitis. Methods: We enrolled 21 patients with suspected acute appendicitis who then underwent emergent ERAT between October 2014 and January 2015. The data of treatment were collected and the operative skills and effects of ERAT were analyzed. Results: ERAT was completed successfully in all the patients, resulting in a success rate of 100%. Mean operation time of ERAT was (49.7±18.2)min and mean hospital stay was (3.3±1.6)d. Cannulation of the appendix lumen was the most critical step of ERAT, and cannulation time [(5.7±4.9)min, P<0.05] was shortened significantly by the use of LoopTip guidewire. Fourteen patients with intraluminal appendicoliths (7 of massive appendicoliths, 4 of sand-like appendicoliths and 3 of sand-like appendicoliths with luminal stenosis) underwent endoscopic lithotomy successfully with balloon or basket, with the success rate of 100%. One patient who presented perforation after appendicolith removal by basket was cured with conservative treatment. Appendix stent was inserted, then pulled out after 1 week in 9 patients, while no complaint or complication of the stent was observed. Operation time of ERAT shortened with the increase of case number. Conclusion: ERAT is an effective and safe therapy for treating patients with uncomplicated acute appendicitis. The high success rate and safety of ERAT will be achieved by selecting suitable instruments for cannulation and appendicolith removal, deciding suitable indications for stenting, and accumulating of operative cases.