Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, Henan 450052, China.
Gastroenterology Hepatology and Nutrition Department, University of Texas Health Science Center at Houston, TX, United States.
Clin Res Hepatol Gastroenterol. 2022 Dec;46(10):102049. doi: 10.1016/j.clinre.2022.102049. Epub 2022 Nov 13.
Acute appendicitis is a common abdominal surgical emergency worldwide. Abraham Groves performed the first documented open appendectomy in 1883. Although appendectomy is still the most effective treatment in cases of acute appendicitis, it causes a range of complications and carries the risk of negative appendectomy. In the awake of covid-19, the latest guidelines recommend antibiotic therapy as an acceptable first line treatment for acute appendicitis. However, patients treated with antibiotics have a recurrence risk of up to 30% at 1 year. Endoscopic retrograde appendicitis therapy (ERAT) has emerged as promising non-invasive treatment modality for acute uncomplicated appendicitis (AUA) which involves cannulation, appedicography, appendiceal stone extraction, appendiceal lumen irrigation, and stent insertion. ERAT aims to relieve the cause of appendicitis (e.g., obstruction or stenosis of the appendiceal lumen) and thus effectively prevent the recurrence of appendicitis. In addition, it can make a definitive diagnosis of acute appendicitis during endoscopic retrograde appendicography. Studies have shown that 93.8 to 95% of AUA patients did not have a recurrence following ERAT. In this study, we aim to summarize the current body of evidence on ERAT to situate it alongside currently established therapies for acute appendicitis, in particular, AUA.
急性阑尾炎是全球常见的腹部外科急症。Abraham Groves 于 1883 年进行了首例有记录的阑尾开放切除术。尽管阑尾切除术仍然是治疗急性阑尾炎最有效的方法，但它会引起一系列并发症，并存在阴性阑尾切除术的风险。在新冠疫情期间，最新指南建议抗生素治疗作为急性阑尾炎的一线治疗方法。然而，接受抗生素治疗的患者在 1 年内的复发风险高达 30%。内镜逆行性阑尾炎治疗 (ERAT) 已成为一种有前途的非侵入性治疗急性单纯性阑尾炎 (AUA) 的方法，该方法包括插管、阑尾造影、阑尾结石取出、阑尾腔冲洗和支架插入。ERAT 的目的是缓解阑尾炎的病因（例如阑尾腔的阻塞或狭窄），从而有效预防阑尾炎的复发。此外，它可以在逆行性阑尾造影时做出急性阑尾炎的明确诊断。研究表明，93.8%至 95%的 AUA 患者在接受 ERAT 治疗后没有复发。在这项研究中，我们旨在总结 ERAT 的现有证据，将其与急性阑尾炎的现有治疗方法，特别是 AUA 进行比较。
