Outcomes of Endoscopic Retrograde Appendicitis Therapy (ERAT) Vs Laparoscopic Appendectomy (LA): A systematic review and meta-analysis

Pub Date : 2023-10-01 DOI:10.1016/j.ijso.2023.100688

Sunil Basukala, Oshan Shrestha, Niranjan Thapa, Sagun Karki, Kabita Chaudhary, Kala Shrestha

{"title":"Outcomes of Endoscopic Retrograde Appendicitis Therapy (ERAT) Vs Laparoscopic Appendectomy (LA): A systematic review and meta-analysis","authors":"Sunil Basukala, Oshan Shrestha, Niranjan Thapa, Sagun Karki, Kabita Chaudhary, Kala Shrestha","doi":"10.1016/j.ijso.2023.100688","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>Endoscopic retrograde appendicitis therapy (ERAT) is a new colonoscopy-based, non-invasive procedure used in the management of acute appendicitis. The results and future prospects of ERAT seem promising. In this study, we aim to study and compare the outcomes of the management of acute appendicitis done through ERAT and laparoscopic appendectomy.</p></div><div><h3>Methods</h3><p>The protocol for this study was prospectively registered. Electronic databases were searched for relevant articles, and all the comparative studies that compared the results of ERAT and laparoscopic appendectomy published in English were included. The mean difference was used as an effect measure for continuous variables, and the odds ratio was used for dichotomous data.</p></div><div><h3>Results</h3><p>Compared to laparoscopic appendectomy, ERAT had 10.93 min lesser procedural time (MD: 10.93; 95% CI: (−14.46) – (−7.40); n = 404; I<sup>2</sup> = 92%, p-value= < 0.00001), 5.46 times lesser odds of achieving technical success (OR: 5.46; 95% CI: 1.17–25.53; n = 329; I<sup>2</sup> = 0%, p-value = 0.03), 14.25 times more odds of developing recurrence (OR: 14.25; 95% CI: 2.67–76.12; n = 327; I<sup>2</sup> = 0%, p-value = 0.002), and cost of care was 611.99 USD lesser (MD: 611.99; 95% CI: (−940.48) – (−283.51); n = 204; I<sup>2</sup> = 98%, p-value = 0.0003). Analysis of length of hospital stay and adverse events did not show a significant difference between the two groups.</p></div><div><h3>Conclusion</h3><p>ERAT is a safe and appendix-conserving procedure that has a lesser procedural time compared to laparoscopic appendectomy; however, recurrence and therapeutic failure remain higher in the ERAT group.</p></div>","PeriodicalId":0,"journal":{"name":"","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2405857223001018","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

Endoscopic retrograde appendicitis therapy (ERAT) is a new colonoscopy-based, non-invasive procedure used in the management of acute appendicitis. The results and future prospects of ERAT seem promising. In this study, we aim to study and compare the outcomes of the management of acute appendicitis done through ERAT and laparoscopic appendectomy.

Methods

The protocol for this study was prospectively registered. Electronic databases were searched for relevant articles, and all the comparative studies that compared the results of ERAT and laparoscopic appendectomy published in English were included. The mean difference was used as an effect measure for continuous variables, and the odds ratio was used for dichotomous data.

Results

Compared to laparoscopic appendectomy, ERAT had 10.93 min lesser procedural time (MD: 10.93; 95% CI: (−14.46) – (−7.40); n = 404; I² = 92%, p-value= < 0.00001), 5.46 times lesser odds of achieving technical success (OR: 5.46; 95% CI: 1.17–25.53; n = 329; I² = 0%, p-value = 0.03), 14.25 times more odds of developing recurrence (OR: 14.25; 95% CI: 2.67–76.12; n = 327; I² = 0%, p-value = 0.002), and cost of care was 611.99 USD lesser (MD: 611.99; 95% CI: (−940.48) – (−283.51); n = 204; I² = 98%, p-value = 0.0003). Analysis of length of hospital stay and adverse events did not show a significant difference between the two groups.

Conclusion

ERAT is a safe and appendix-conserving procedure that has a lesser procedural time compared to laparoscopic appendectomy; however, recurrence and therapeutic failure remain higher in the ERAT group.

查看原文

内镜逆行性阑尾炎治疗(ERAT)与腹腔镜阑尾切除术(LA)的结果:一项系统综述和荟萃分析

内镜下逆行性阑尾炎治疗（ERAT）是一种新的基于结肠镜检查的非侵入性手术，用于治疗急性阑尾炎。ERAT的结果和未来前景似乎很有希望。在这项研究中，我们的目的是研究和比较通过ERAT和腹腔镜阑尾切除术治疗急性阑尾炎的结果。方法前瞻性登记本研究的方案。在电子数据库中搜索相关文章，并包括所有以英语发表的比较ERAT和腹腔镜阑尾切除术结果的比较研究。平均差被用作连续变量的效应度量，比值比被用于二分数据。结果与腹腔镜阑尾切除术相比，ERAT的手术时间缩短了10.93min（MD:10.93；95%CI:（-14.46）-（-7.40）；n=404；I2＝92%，p值＝<；0.00001），获得技术成功的几率低5.46倍（OR:5.46；95%CI:1.17–25.53；n=329；I2=0%，p值=0.03），复发几率高14.25倍（OR:14.25；95%CI:2.67–76.12；n=327；I2=0%，p价值=0.002），护理成本低611.99美元（MD:611.99；95%CI:（-940.48）–（-283.51）；n=204；I2=98%，p值=0.0003）。住院时间和不良事件的分析显示两组之间没有显著差异。结论ERAT是一种安全、保存阑尾的手术，与腹腔镜阑尾切除术相比，手术时间更短；然而，ERAT组的复发率和治疗失败率仍然较高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文