Is endoscopic retrograde appendicitis therapy a better modality for acute uncomplicated appendicitis? A systematic review and meta-analysis

Table 1 Detailed characteristics of included studies in this meta analysis

Ref.	Studies types	Patients age	Treatment		Sample size		Disease	Outcomes
			Experiment	Control	Experiment	Control
Kang et al[20], 2020	RCT	1 to 13 years old	Modified ERAT	Antibiotics treatment	36	47	Acute uncomplicated appendicitis in children	Length of hospital stay
Deng et al[21], 2018	RCT	18-62 years old	ERAT	Laparoscopic appendectomy	20	20	Acute appendicitis	Duration of operation, Bed rest time; time interval of body temperature returning to normal range; time interval of white blood cells count returning to normal time range, complication
Huang et al[22], 2020	RCT	18-65 years old	ERAT	Laparoscopic appendectomy	78	119	Acute appendicitis	Duration of operation, bed rest time, complication
Lin et al[23], 2016	RCT	18-70 years old	ERAT	Laparoscopic appendectomy/antibiotics treatment	44	45/36	Simple appendicitis	Length of hospital stay, bed rest time, time interval of body temperature returning to normal range, inflammatory factors, complication
Ma et al[24], 2020	RCT	19-74 years old	ERAT	Laparoscopic appendectomy	20	20	Non-complex appendicitis	Duration of operation, length of hospital stay, time interval of body temperature returning to normal range, inflammatory factors, complication
Wang et al[25], 2017	RCT	3 to 13 years old	ERAT	Laparoscopic appendectomy	42	42	Acute uncomplicated appendicitis in children	Duration of operation, length of hospital stay, bed rest time, time interval of body temperature returning to normal range, complication
Pan et al[26], 2018	RCT	19-62 years old	ERAT	Laparoscopic appendectomy	35	36	Acute appendicitis	Duration of operation, length of hospital stay, bed rest time, inflammatory factors
Shen et al[27], 2020	Case-control	NA	ERAT combined with antibiotics treatment	Antibiotics treatment	42	57	Acute appendicitis	Length of hospital stay
Ye et al[28], 2016	RCT	18-70 years old	ERAT	Laparoscopic appendectomy	57	57	Non-perforated acute appendicitis	Length of hospital stay, bed rest time, inflammatory factors, complication
Zhu et al[29], 2018	RCT	NA	ERAT	Antibiotics treatment	17	24	Atypical acute appendicitis	Complication
Yang et al[30], 2016	RCT	20-60 years old	ERAT	Laparoscopic appendectomy	35	35	Acute uncomplicated appendicitis	Duration of operation, bed rest time, length of hospital stay, time interval of body temperature returning to normal range
Li et al[31], 2016	Case-control	14-73 years old	ERAT	Laparoscopic appendectomy	21	20	Uncomplicated acute appendicitis	Duration of operation, length of hospital stay, bed rest time, time interval of body temperature returning to normal range, time interval of white blood cells count returning to normal time range, complication

ERAT: Endoscopic retrograde appendicitis therapy.

Table 2 Detailed quality assessment of included studies using modified Jadad score

Ref.	Randomization	Concealment of allocation	Double blinding	Description of withdrawals and dropouts	Total score
Kang et al[1], 2018	2	0	0	1	3
Deng et al[2], 2018	0	0	0	1	1
Huang et al[3], 2020	2	0	0	0	0
Lin et al[4], 2016	0	0	0	0	0
Ma et al[5], 2020	1	0	0	0	1
Wang et al[6], 2017	2	0	0	0	2
Pan et al[7], 2018	2	0	0	0	2
Wu et al[9], 2019	0	0	0	1	1
Ye et al[10], 2016	0	0	0	1	1
Zhang et al[11], 2017	1	0	0	0	1
Zhu et al[12], 2018	2	0	0	1	3
Yang et al[13], 2016	2	0	0	0	2

Table 3 Pooled results of inflammatory factors and complications

Outcomes	Categories	Number of records	OR/WMD and 95%CI	P	Heterogeneity with groups (I2)	Phet value
Inflammatory factors
	C-reactive protein (pre)	3	-0.28, [-1.14, 0.58]	0.53	72%	0.03
	C-reactive protein (post)	3	-10.06, [-17.39, -2.73]	0.007	98.0%	< 0.001
	Tumor necrosis factor-α (pre)	2	-0.21, [-1.32, 0.90]	0.71	0.0%	0.68
	Tumor necrosis factor-α (post)	2	7.70, [-8.47, -6.93]	< 0.001	99.0%	< 0.001
	Interleukin 6 (pre)	3	-0.11, [-1.04, 0.82]	0.81	6.0%	0.34
	Interleukin 6 (post)	3	-9.78, [-10.69, -8.88]	< 0.001	99.0%	< 0.001
Complications
	Intestinal obstruction	4	0.19, [0.05, 0.79]	0.020	0.0%	0.95
	Abdominal infection	2	0.10, [0.01, 0.83]	0.030	0.0%	0.44
	Urinary tract infection	3	0.27, [0.04, 1.65]	0.160	0.0%	0.97

Table 4 Publication bias of outcomes by Egger’s test and Begg’s test

	Egger’s test		Begg’s test
	t	P	Z	P
Time interval of body temperature returning to normal rangetime	1.17	0.306	0.75	0.452
Time interval of White white blood cells count returning to normal timerange	-	-	0.00	1.00
Duration of operation	-0.9	0.409	1.2	0.230
Length of hospitalizations (vs LA)	-0.48	0.648	0.37	0.711
Length of hospitalizations (vs Anti)	-1.72	0.336	0.00	1.00
CRP (pre-operative)	2.23	0.268	1.04	0.296
CRP (post-operative)	-0.19	0.878	0.00	1.00
TNF-α (pre-operative)	-	-	0.00	1.00
TNF-α (post-operative)	-	-	0.00	1.00
IL-6 (pre-operative)	-1.27	0.425	0.00	1.00
IL-6 (post-operative)	-7.43	0.085	1.04	0.296
Intestinal obstruction	2.03	0.179	1.70	0.089
Abdominal infection	-	-	0.00	1.00
Urinary tract infection	11.87	0.053	0.00	1.00
Bed rest time	-3.1	0.021	1.11	0.266

LA: Laparoscopic appendectomy.