Outcomes of Endoscopic Retrograde Appendicitis Therapy (ERAT) Vs Laparoscopic Appendectomy (LA): A systematic review and meta-analysis

Abstract

Introduction

Endoscopic retrograde appendicitis therapy (ERAT) is a new colonoscopy-based, non-invasive procedure used in the management of acute appendicitis. The results and future prospects of ERAT seem promising. In this study, we aim to study and compare the outcomes of the management of acute appendicitis done through ERAT and laparoscopic appendectomy.

Methods

The protocol for this study was prospectively registered. Electronic databases were searched for relevant articles, and all the comparative studies that compared the results of ERAT and laparoscopic appendectomy published in English were included. The mean difference was used as an effect measure for continuous variables, and the odds ratio was used for dichotomous data.

Results

Compared to laparoscopic appendectomy, ERAT had 10.93 min lesser procedural time (MD: 10.93; 95% CI: (−14.46) – (−7.40); n = 404; I² = 92%, p-value= < 0.00001), 5.46 times lesser odds of achieving technical success (OR: 5.46; 95% CI: 1.17–25.53; n = 329; I² = 0%, p-value = 0.03), 14.25 times more odds of developing recurrence (OR: 14.25; 95% CI: 2.67–76.12; n = 327; I² = 0%, p-value = 0.002), and cost of care was 611.99 USD lesser (MD: 611.99; 95% CI: (−940.48) – (−283.51); n = 204; I² = 98%, p-value = 0.0003). Analysis of length of hospital stay and adverse events did not show a significant difference between the two groups.

Conclusion

ERAT is a safe and appendix-conserving procedure that has a lesser procedural time compared to laparoscopic appendectomy; however, recurrence and therapeutic failure remain higher in the ERAT group.