Wang Ying, Sun Chen-Yu, Liu Jie, Chen Yue, Bhan Chandur, Tuason John Pocholo Whitaker, Misra Sudha, Huang Yu-Ting, Ma Shao-Di, Cheng Xing-Yu, Zhou Qin, Gu Wen-Chao, Wu Dan-Dan, Chen Xia
Department of Endoscopy Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China.
Internal Medicine, AMITA Health Saint Joseph Hospital Chicago, Chicago, IL 60657, United States.
World J Clin Cases. 2021 Nov 26;9(33):10208-10221. doi: 10.12998/wjcc.v9.i33.10208.
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).
To compare the effectiveness of ERAT with LA.
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.
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; = 0.007] was shorter than LA group. Secondly, the level of post-operative CRP [WMD = -10.06, 95%CI: (-17.39, -2.73); = 0.007], TNF-α [WMD = -7.70, 95%CI: (-8.47, -6.93); 0.001], and IL-6 Levels [WMD = -9.78, 95%CI: (-10.69, -8.88); 0.001; 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); = 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).
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.
既往研究表明，内镜逆行性阑尾炎治疗术（ERAT）是治疗急性阑尾炎的一种有效方法。然而，不同研究报道了ERAT与腹腔镜阑尾切除术（LA）相比疗效存在冲突。
比较ERAT与LA的疗效。
从建库至2021年3月1日，在PubMed、Cochrane图书馆、科学网、Embase数据库、中国知网、万方数据库和维普数据库中检索ERAT治疗急性单纯性阑尾炎的随机对照试验（RCT）和回顾性研究。使用I²统计量评估异质性。通过固定效应或随机效应模型计算合并比值比（OR）、加权均数差（WMD）和标准化均数差（SMD），并给出95%置信区间（CI）。同时进行敏感性分析。采用Egger检验和Begg检验检测发表偏倚。纳入的RCT质量采用Jadad量表评估，病例对照研究的方法学质量采用纽卡斯尔-渥太华量表评估。所有统计分析均使用Stata 15.1统计软件。本研究已在国际前瞻性系统评价注册平台（PROSPERO）注册，注册号为CRD42021243955。
经过筛选，本系统评价纳入了10项RCT和2项病例对照研究。首先，ERAT组的住院时间[WMD = -1.15，95%CI：-1.99，-0.31；P = 0.007]比LA组短。其次，ERAT组术后C反应蛋白（CRP）水平[WMD = -10.06，95%CI：（-17.39，-2.73）；P = 0.007]、肿瘤坏死因子-α（TNF-α）水平[WMD = -7.70，95%CI：（-8.47，-6.93）；P < 0.001]和白细胞介素-6（IL-6）水平[WMD = -9.78，95%CI：（-10.69，-8.88）；P < 0.001；I² = 0.001]均显著低于LA组。第三，ERAT组肠梗阻发生率低于LA组[OR = 0.19，95%CI：（0.05，0.79）；P = 0.020]。此外，10项RCT的质量较低，Jadad评分在0 - 3分之间，而2项病例对照研究的方法学质量一般，评分为2分（每项）。
与LA相比，ERAT可缩短手术时间，降低术后炎症水平，减少并发症，缩短恢复时间，同时保留阑尾及其免疫和生物学功能。
