Ma Li-Yun, Hu Jian-Wei, Cai Xian-Li, Liu Zu-Qiang, Zhong Yun-Shi, Lin Sheng-Li, Chen Tian-Yin, Cai Si-Lun, Zhang Yi-Qun, Chen Wei-Feng, Ma Li-Li, Cai Ming-Yan, Qin Wen-Zheng, Ma Xiao, Li Quan-Lin, Zhou Ping-Hong
Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, China.
Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China.
Surg Endosc. 2025 Jan;39(1):409-416. doi: 10.1007/s00464-024-11339-z. Epub 2024 Nov 21.
Chronic appendicitis is a condition with chronic abdominal pain or mild attacks of appendicitis, seriously affecting the patient's quality of life. Endoscopic retrograde appendicitis therapy (ERAT) has emerged as a promising, non-invasive treatment for acute uncomplicated appendicitis. Here, we aim to assess the safety and efficacy of ERAT for chronic fecalith appendicitis.
We retrospectively reviewed the medical records of consecutive patients who underwent ERAT for chronic fecalith appendicitis at Zhongshan Hospital, Fudan University, Shanghai, China between December 2017 and June 2023. Clinicopathological characteristics, procedure-related parameters, AEs, and follow-up outcomes were analyzed.
A total of 60 patients were included. ERAT intubation was successfully performed in all patients (100%). The median procedure time was 15 min (IQR, 12-25 min). The postoperative abdominal pain scores were significantly reduced (P < 0.0001). Short-term adverse events included 5 cases of abdominal pain (8.3%) and 2 cases of fever (3.3%). Long-term adverse events included recurrent abdominal pain in 3 cases (5.0%) and recurrent appendicitis in 2 cases (3.3%). The median time to recurrence was 5 months (IQR, 2-12 months). Logistic regression analysis revealed appendiceal stenosis (OR 25.000, 95% CI 1.114-561.281, P = 0.043) and distorted appendix lumen (OR 12.500, 95% CI 1.373-113.806, P = 0.025) as significant risk factors for long-term adverse events.
ERAT may be a safe, effective and minimally invasive alternative approach for chronic fecalith appendicitis. Appendix lumen stenosis and distortion are risk factors of recurrence. Further large-scale prospective studies are necessary to assess the efficacy and safety of ERAT compared with antibiotic therapy and surgery.
慢性阑尾炎是一种伴有慢性腹痛或轻度阑尾炎发作的疾病，严重影响患者的生活质量。内镜逆行阑尾炎治疗术（ERAT）已成为一种有前景的、用于治疗急性单纯性阑尾炎的非侵入性治疗方法。在此，我们旨在评估ERAT治疗慢性粪石性阑尾炎的安全性和有效性。
我们回顾性分析了2017年12月至2023年6月期间在上海复旦大学附属中山医院接受ERAT治疗慢性粪石性阑尾炎的连续患者的病历。分析临床病理特征、手术相关参数、不良事件及随访结果。
共纳入60例患者。所有患者（100%）均成功完成ERAT插管。中位手术时间为15分钟（四分位间距，12 - 25分钟）。术后腹痛评分显著降低（P < 0.0001）。短期不良事件包括5例腹痛（8.3%）和2例发热（3.3%）。长期不良事件包括3例复发性腹痛（5.0%）和2例复发性阑尾炎（3.3%）。复发的中位时间为5个月（四分位间距，2 - 12个月）。逻辑回归分析显示阑尾狭窄（比值比25.000，95%置信区间1.114 - 561.281，P = 0.043）和阑尾腔扭曲（比值比12.500，95%置信区间1.373 - 113.806，P = 0.025）是长期不良事件的显著危险因素。
ERAT可能是治疗慢性粪石性阑尾炎的一种安全、有效且微创的替代方法。阑尾腔狭窄和扭曲是复发的危险因素。与抗生素治疗和手术相比，有必要进行进一步的大规模前瞻性研究以评估ERAT的疗效和安全性。
