Visual Endoscopic Retrograde Appendicitis Therapy versus Antibiotic Therapy for Treatment of Uncomplicated Acute Appendicitis.

IF 8 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY American Journal of Gastroenterology Pub Date : 2024-10-09 DOI:10.14309/ajg.0000000000003118

Ke Zhan, Yang Bai, Tianyu Liu, Xing Su, Qingqing Yang, Yang Liu, Xiangrong Zhou, Yichuan Zhang, Jianhua Tang, Zheng Jiang, Xin Yang, Weihui Liu

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Abstract

Background: Visual endoscopic retrograde appendicitis therapy (V-ERAT) involves a Single-use Video Scope, allowing real-time visualization of the appendiceal lumen during the procedure to treat uncomplicated acute appendicitis (AA). This study aims to compare V-ERAT to antibiotic therapy in treating uncomplicated AA.

Methods: This multicenter, retrospective cohort study was conducted at nine hospitals in China from August 2021 to July 2023. Propensity score matching was performed to minimize selection bias. A total of 692 uncomplicated AA patients were included, with 188 undergoing V-ERAT and 504 receiving antibiotic therapy. The primary outcome was treatment success rate. The secondary outcomes included recurrent appendicitis rate, the appendectomy rate during the initial hospitalization, length of initial hospitalization, time to disease recurrence, and overall adverse events.

Results: The treatment success rate did not differ between the V-ERAT and antibiotic groups (93.6%; 95% confidence interval [CI] 89.1% to 96.7% vs. 90.5%; 95% CI, 87.6% to 92.9%) ( P = 0.225). However, V-ERAT demonstrated a significantly lower risk of appendicitis recurrence compared to antibiotic therapy during the follow-up (log-rank P < 0.001), with a hazard ratio of 0.14 (95% CI 0.07-0.29, P < 0.001). V-ERAT was associated with a lower appendectomy rate during the initial hospitalization (4.3%; 95% CI, 1.9% to 8.2% vs. 9.5%; 95% CI, 7.1 to 12.4%) (P = 0.027), a shorter length of initial hospitalization (3 [IQR, 3-4] vs. 4 [IQR, 4-6] days, P < 0.001), and a longer time to recurrence (269 [IQR, 210-318] vs. 70 [IQR, 21-103] days, P < 0.001). The overall adverse event rates did not differ between the two groups (log-rank P = 0.064).

Conclusion: V-ERAT appears to be a safe and effective alternative to antibiotic therapy in treating uncomplicated AA, significantly reducing the risk of appendicitis recurrence.

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治疗无并发症急性阑尾炎的可视内镜逆行阑尾炎疗法与抗生素疗法。

背景：可视内镜逆行性阑尾炎治疗（V-ERAT）采用一次性使用视频镜，可在治疗无并发症急性阑尾炎（AA）的过程中实时观察阑尾管腔。本研究旨在比较 V-ERAT 和抗生素疗法治疗无并发症急性阑尾炎的效果：这项多中心、回顾性队列研究于 2021 年 8 月至 2023 年 7 月在中国九家医院进行。为减少选择偏倚，进行了倾向评分匹配。共纳入了692名无并发症的AA患者，其中188人接受了V-ERAT治疗，504人接受了抗生素治疗。主要结果是治疗成功率。次要结果包括阑尾炎复发率、首次住院期间阑尾切除率、首次住院时间、疾病复发时间和总体不良事件：V-ERAT组和抗生素组的治疗成功率没有差异（93.6%；95% 置信区间 [CI] 89.1%至96.7% vs. 90.5%；95% CI，87.6%至92.9%）（P = 0.225）。然而，在随访期间，与抗生素治疗相比，V-ERAT明显降低了阑尾炎复发的风险（log-rank P < 0.001），危险比为0.14（95% CI 0.07-0.29，P < 0.001）。V-ERAT 与初始住院期间阑尾切除率较低（4.3%；95% CI，1.9% 至 8.2% vs. 9.5%；95% CI，7.1% 至 12.4%）（P = 0.027），初始住院时间较短（3 [IQR, 3-4] 天 vs. 4 [IQR, 4-6] 天，P < 0.001），复发时间较长（269 [IQR, 210-318] 天 vs. 70 [IQR, 21-103] 天，P < 0.001）。两组的总体不良事件发生率没有差异（log-rank P = 0.064）：V-ERAT似乎是治疗无并发症AA的抗生素疗法的一种安全有效的替代疗法，能显著降低阑尾炎复发的风险。

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来源期刊

American Journal of Gastroenterology 医学-胃肠肝病学

CiteScore

11.40

自引率

5.10%

发文量

458

审稿时长

12 months

期刊介绍： Published on behalf of the American College of Gastroenterology (ACG), The American Journal of Gastroenterology (AJG) stands as the foremost clinical journal in the fields of gastroenterology and hepatology. AJG offers practical and professional support to clinicians addressing the most prevalent gastroenterological disorders in patients.