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The modified endoscopic retrograde appendicitis therapy versus antibiotic therapy alone for acute uncomplicated appendicitis in children

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Abstract

Background

Endoscopic retrograde appendicitis therapy (ERAT) is an emerging endoscopic treatment modality for acute uncomplicated appendicitis (AUA) supported by several case series. However, to date, systematic studies have not been conducted in children and the prospective comparative data are lacking. Moreover, due to a concern for future malignancy risk in children from ionizing radiation, we used contrast-enhanced ultrasound (CEUS) instead of endoscopic retrograde appendiceal radiography (ERAR). Therefore, we conducted a prospective, randomized control clinical trial to compare the modified ERAT (mERAT) to antibiotic therapy in children with AUA. The aim of this study was to evaluate the safety and feasibility and of mERAT in the treatment of hospitalized children with AUA.

Methods

Children with AUA, confirmed by ultrasonography and or abdominal computed tomography, were consecutively enrolled from October 2018 to February, 2020. They were randomly assigned to receive mERAT or routine antibiotic treatment. Patients were followed until May, 2020. Th primary outcome variable was the duration of relief of the abdominal pain after treatment. We collected patient’s demographics, ultrasonic imaging findings, colonoscopy findings, and treatment outcomes of the mERAT and adverse even associated with mERAT.

Results

A total of 83 children were enrolled. 36 were randomized to mERAT and 47 to antibiotics treatment. All children in the mERAT group had endoscopic confirmed acute uncomplicated appendicitis, and there were no significant complications. However, 9 of patients in antibiotic group were poor responsive to treatment and switched to mERAT. The overall success rate of treatment with mERAT (100%) was significantly higher than that of antibiotics (80.9%) (P = 0.004). The median time to discharge was significantly shorter in mERAT group than in antibiotics treatment group [6.0 ± 1.76 days] (P = 0.004).

Conclusions

mERAT provide a new alternative therapeutic option for childhood with AUA, especially for families who are reluctant to undergo an appendectomy.

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Acknowledgements

This work was supported by grants from the Innovation Foundation of Tangdu Hospital of Fourth Military Medical University (2019LCYJ007) and the new technology and new business Foundation of Tangdu Hospital of Fourth Military Medical University of China (XZ201997). We express our gratitude to all those who helped us during this study. We especially acknowledge Dr. Ding-yong Li for reviewing our manuscript.

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Author notes

  1. Jianqin Kang and Wei Zhang contributed equally to this work.

Authors and Affiliations

  1. Department of Pediatrics, Tangdu Hospital, Fourth Military Medical University, 1 Xinsi Road, Xi’an, 710038, Shaanxi Province, China

    Jianqin Kang, Wei Zhang, Lingchao Zeng, Yan Lin, Junqing Wu, Nini Zhang, Xiaomin Xie, Yu Zhang, Xiangzeng Liu, Baoxi Wang & Xun Jiang

  2. Department of Ultrasonics, Tangdu Hospital, Fourth Military Medical University, 1 Xinsi Road, Xi’an, 710038, Shaanxi Province, China

    Ruijing Yang

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Jianqin Kang, Wei Zhang, Lingchao Zeng, Yan Lin, Junqing Wu, Nini Zhang, Xiaomin Xie, Yu Zhang, Xiangzeng Liu, Baoxi Wang, Ruijing Yang, Xun Jiang have no conflicts of interest or financial ties to disclose.

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Kang, J., Zhang, W., Zeng, L. et al. The modified endoscopic retrograde appendicitis therapy versus antibiotic therapy alone for acute uncomplicated appendicitis in children. Surg Endosc 35, 6291–6299 (2021). https://doi.org/10.1007/s00464-020-08129-8

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