Endoscopic retrograde appendicitis therapy: a pilot minimally invasive technique (with videos)

• Published in: Gastrointestinal endoscopy 2012-10, Vol.76 (4), p.862-866
• Main Authors: Liu, Bing-Rong, MD, Song, Ji-Tao, PhD, Han, Fu-You, MD, Li, Hui, PhD, Yin, Ji-Bin, PhD
• Format: Article
• Language: English
• Subjects: Acute Disease; Adolescent; Adult; Appendicitis - diagnostic imaging; Appendicitis - therapy; Biological and medical sciences; Child; Colonoscopes; Drainage - instrumentation; Drainage - methods; Endoscopy, Gastrointestinal - instrumentation; Endoscopy, Gastrointestinal - methods; Female; Follow-Up Studies; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Pilot Projects; Radiography; Retrospective Studies; Stents; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Treatment Outcome; Young Adult
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2012.05.029

Background Inspired by the success of ERCP for the treatment of suppurative cholangitis, we investigated a new minimally invasive method for the treatment of acute uncomplicated appendicitis, which we call endoscopic retrograde appendicitis therapy. Objective To investigate the feasibility and efficacy of endoscopic retrograde appendicitis therapy for the treatment of acute uncomplicated appendicitis. Design and Setting A retrospective, single-center study at an academic medical center. Patients Four patients with acute uncomplicated appendicitis. Interventions There were 5 steps after insertion of a colonoscope into the cecum and identification of the appendiceal orifice: (1) endoscopic appendiceal intubation; (2) appendiceal decompression; (3) retrograde appendicography; (4) stent drainage; and (5) cleansing the appendiceal lumen. Main Outcome Measurements The rate of successful endoscopic intubation and decompression, the time to symptom relief, the time to disappearance of signs, increased white blood cell count, procedure-related complications, and recurrence, if any. Results All 4 endoscopic appendiceal intubations were successful. Pain was relieved immediately after endoscopic decompression and stent drainage. Leukocytosis returned to normal within 24 hours. There were no complications and no recurrences during 4 to 19 months of follow-up. Limitations Small sample size, single-center study without controls. Conclusion Endoscopic retrograde appendicitis therapy is a feasible and effective endoscopic treatment modality for acute uncomplicated appendicitis.