V-ERAT better than antibiotics for treatment of uncomplicated acute appendicitis

Patients with uncomplicated acute appendicitis may opt for visual endoscopic retrograde appendicitis therapy (V-ERAT) as a safe and effective alternative to antibiotic treatment to reduce the risk of recurrence, according to a study.

Treatment success rates were similar between the V-ERAT (93.6 percent, 95 percent confidence interval [CI], 89.1‒96.7) and antibiotic groups (90.5 percent, 95 percent CI, 87.6‒92.9; p=0.225). However, V-ERAT resulted in a much lower risk of recurrence than antibiotic use during follow-up (hazard ratio, 0.14, 95 percent CI, 0.07‒0.29; p<0.001).

Additionally, V-ERAT correlated with a lower rate of appendectomy during the initial hospitalization (4.3 percent vs 9.5 percent; p=0.027), a shorter length of initial hospitalization (3 vs 4 days; p<0.001), and a longer time to recurrence (269 vs 70 days; p<0.001) compared with antibiotic therapy.

On the other hand, the two groups showed no significant difference in terms of overall adverse event rates (log-rank p=0.064).

The authors conducted this multicentre, retrospective cohort study at nine hospitals in China from August 2021 to July 2023 and performed propensity score matching to minimize selection bias. They included 692 patients with uncomplicated acute appendicitis, of whom 188 underwent V-ERAT and 504 received antibiotic therapy.

Treatment success rate was the primary outcome, while recurrent appendicitis rate, the appendectomy rate during the initial hospitalization, length of initial hospitalization, time to disease recurrence, and overall adverse events were secondary.