Endoscopic retrograde appendicitis therapy versus appendectomy or antibiotics in the modern approach to uncomplicated acute appendicitis: A systematic review and meta-analysis

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• dc.contributor.author Pata, Francesco
• dc.contributor.author Nardo, Bruno
• dc.contributor.author Ielpo, Benedetto
• dc.contributor.author Di Martino, Marcello
• dc.contributor.author Murzi, Valentina
• dc.contributor.author Di Saverio, Salomone
• dc.contributor.author Yang, Baohong
• dc.contributor.author Ortenzi, Monica
• dc.contributor.author Pisanu, Adolfo
• dc.contributor.author Pellino, Gianluca
• dc.contributor.author Podda, Mauro
• dc.date.accessioned 2024-06-03T06:30:19Z
• dc.date.available 2024-06-03T06:30:19Z
• dc.date.issued 2023
• dc.description.abstract Introduction: Endoscopic retrograde appendicitis therapy has been proposed as an alternative strategy for treating appendicitis, but debate exists on its role compared with conventional treatment. Methods: This systematic review was performed on MEDLINE, Cochrane Central Register of Controlled Trials, and EMBASE. The last search was in April of 2023. The risk ratio with a 95% confidence interval was calculated for dichotomous variables, and the mean difference with a 95% confidence interval for continuous variables. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool (randomized controlled trials) and the Risk of Bias in Non-Randomized Studies of Intervention tool (non-randomized controlled trials). Results: Six studies met the eligibility criteria. Four studies compared endoscopic retrograde appendicitis therapy (n = 236 patients) and appendectomy (n = 339) and found no differences in technical success during index admission (risk ratio 0.97, 95% confidence interval [0.92,1.02]). Appendectomy showed superior outcomes for recurrence at 1-year follow-up (risk ratio 11.28, 95% confidence interval [2.61,48.73]). Endoscopic retrograde appendicitis therapy required shorter procedural time (mean difference -14.38, 95% confidence interval [-20.17, -8.59]) and length of hospital stay (mean difference -1.19, 95% confidence interval [-2.37, -0.01]), with lower post-intervention abdominal pain (risk ratio 0.21, 95% confidence interval [0.14,0.32]). Two studies compared endoscopic retrograde appendicitis therapy (n = 269) and antibiotic treatment (n = 280). Technical success during admission (risk ratio 1.11, 95% confidence interval [0.91,1.35]) and appendicitis recurrence (risk ratio 1.07, 95% confidence interval [0.08,14.87]) did not differ, but endoscopic retrograde appendicitis therapy decreased the length of hospitalization (mean difference -1.91, 95% confidence interval [-3.18, -0.64]). Conclusion: This meta-analysis did not identify significant differences between endoscopic retrograde appendicitis therapy and appendectomy or antibiotics regarding technical success during index admission and treatment efficacy at 1-year follow-up. However, a high risk of imprecision limits these results. The advantages of endoscopic retrograde appendicitis therapy in terms of reduced procedural times and shorter lengths of stay must be balanced against the increased risk of having an appendicitis recurrence at one year.
• dc.format.mimetype application/pdf
• dc.identifier.citation Pata F, Nardo B, Ielpo B, Di Martino M, Murzi V, Di Saverio S, et al. Endoscopic retrograde appendicitis therapy versus appendectomy or antibiotics in the modern approach to uncomplicated acute appendicitis: A systematic review and meta-analysis. Surgery. 2023 Dec;174(6):1292-301. DOI: 10.1016/j.surg.2023.08.029
• dc.identifier.doi http://dx.doi.org/10.1016/j.surg.2023.08.029
• dc.identifier.issn 0039-6060
• dc.identifier.uri http://hdl.handle.net/10230/60328
• dc.language.iso eng
• dc.publisher Elsevier
• dc.relation.ispartof Surgery. 2023 Dec;174(6):1292-301
• dc.rights © 2023 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.other Apendicitis --Tractament
• dc.title Endoscopic retrograde appendicitis therapy versus appendectomy or antibiotics in the modern approach to uncomplicated acute appendicitis: A systematic review and meta-analysis
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion