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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Is endoscopic retrograde appendicitis therapy a better modality for acute uncomplicated appendicitis? A systematic review and meta-analysis
Ying Wang, Chen-Yu Sun, Jie Liu, Yue Chen, Chandur Bhan, John Pocholo Whitaker Tuason, Sudha Misra, Yu-Ting Huang, Shao-Di Ma, Xing-Yu Cheng, Qin Zhou, Wen-Chao Gu, Dan-Dan Wu, Xia Chen
Ying Wang, Dan-Dan Wu, Department of Endoscopy Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
Chen-Yu Sun, Chandur Bhan, John Pocholo Whitaker Tuason, Sudha Misra, Internal Medicine, AMITA Health Saint Joseph Hospital Chicago, Chicago, IL 60657, United States
Jie Liu, Department of Gastroenterology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
Yue Chen, Xing-Yu Cheng, Department of Clinical Medicine, School of the First Clinical Medicine, Anhui Medical University, Hefei 230032, Anhui Province, China
Yu-Ting Huang, University of Maryland Medical Center Midtown Campus, Baltimore, MD 21201, United States
Shao-Di Ma, Department of Epidemiology and Health Statistics, School of Public Health Anhui Medical University, Hefei 230032, Anhui Province, China
Qin Zhou, Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, United States
Wen-Chao Gu, Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
Xia Chen, Department of Nursing,The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
Author contributions: Wu DD, Chen X, Wang Y, Liu J and Sun CY designed the research study; Wang Y, Sun CY and Chen Y selected and collected the data; Wang Y, Sun CY and Liu J analyzed the data; Bhan C, Tuason JPW, Misra S, Huang YT, Ma SD, Cheng XY, Zhou Q and Gu WC provided critical opinions and revised the manuscript; Wang Y and Sun CY wrote the manuscript; Wang Y, Sun CY and Liu J contributed equally to this work and should be considered as co-first authors; all authors approved the final manuscript.
Conflict-of-interest statement: Allauthors have no conflict(s) of interest to declare in relation to this manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised in accordance with this checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Wu Dan-Dan, MSN, RN, Associate Chief Nurse, Department of Endoscopy Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Hefei 230001, Anhui Province, China. 16013255@qq.com
Received: June 5, 2021
Peer-review started: June 5, 2021
First decision: June 27, 2021
Revised: August 1, 2021
Accepted: October 14, 2021
Article in press: October 14, 2021
Published online: November 26, 2021
ARTICLE HIGHLIGHTS
Research background
Evidence from revious studies shown that endoscopic retrograde appendicitis therapy (ERAT) is an effective treatment for acute appendicitis.
Research motivation
However, different studies reported conflicting outcomes regarding the effectiveness of ERAT in comparison with laparoscopic appendectomy (LA).
Research objectives
This meta-analysis was conducted to compare the effectiveness of ERAT with LA.
Research methods
Randomized controlled trials and retrospective studies of ERAT for acute uncomplicated appendicitis were searched in PubMed, Cochrane Library, Web of Science, Embase database, China National Knowledge Infrastructure (CNKI), the WanFang Database, and Chinese Scientific Journals Database (VIP).
Research results
10 randomized controlled studies (RCTs) and 2 case-control studies were included in the current systematic review. Firstly, the length of hospitalizations [WMD = -1.15, 95%CI: (-1.99, -0.31); P = 0.007] was shorter than LA group. Secondly, the level of post-operative CRP [WMD = -10.06, 95%CI: (-17.39, -2.73); P = 0.007], TNF-α [WMD = -7.70, 95%CI: (-8.47, -6.93); P < 0.001], and IL-6 Levels [WMD = -9.78, 95%CI: (-10.69, -8.88); P < 0.001; P < 0.001] in ERAT group was significantly lower than LA group. Thirdly, ERAT group had a lower incidence of intestinal obstruction than LA group. [OR = 0.19, 95%CI: (0.05, 0.79); P = 0.020].
Research conclusions
Based on our meta-analysis, it is found that ERAT has its own unique advantages of being more effective, safer compared with LA.
Research perspectives
As little study compared LA with antibiotics treatment, future study should focus on comparing the effectiveness between LA and antibiotics treatment.
