Objectives To evaluate the clinical efficacy of endoscopic retrograde appendicitis therapy (ERAT) in the management of acute appendicitis in pediatric patients. Methods A comprehensive search was conducted across seven electronic databases. Methodological quality of included studies was assessed using the Cochrane risk of bias tool. Statistical analyses were performed using RevMan 5.3 and Stata 13 software. Results Ten studies involving 1,372 pediatric patients were included (ERAT group: 660; control group: 712). Compared to the control group, the ERAT group demonstrated significant advantages in multiple outcomes: shorter operative time [WMD = − 9.98, 95%CI: (-17.47, − 2.49); P = 0.009], higher fecalith detection rate [RR = 1.81, 95%CI: (1.43, 2.30); P < 0.00001], shorter postoperative feeding time [SMD = − 3.21, 95%CI: (− 4.04, − 2.38); P < 0.00001], lower postoperative white blood cell count [WMD = − 1.45, 95%CI: (− 1.93, − 0.96); P < 0.00001], faster normalization of white blood cell levels [WMD = − 1.62, 95%CI: (− 2.03, − 1.20); P < 0.00001], quicker resolution of fever [WMD = − 1.15, 95%CI: (− 1.48, − 0.81); P < 0.00001], shorter duration of abdominal pain relief [SMD = − 1.18, 95%CI: (− 1.59, − 0.77); P < 0.00001], reduced bed rest time [WMD = − 1.39, 95%CI: (− 1.61, − 1.18); P < 0.00001], fewer complications [RR = 0.27, 95%CI: (0.18, 0.39); P < 0.00001], higher initial treatment success rate [RR = 1.11, 95%CI: (1.06, 1.16); P < 0.0001], shorter hospital stay [WMD = − 2.21, 95%CI: (− 2.69, − 1.73); P < 0.00001], and lower hospitalization costs [SMD = − 2.84, 95%CI: (− 3.47, − 2.20); P < 0.00001]. However, no statistically significant difference was observed in recurrence rates between groups [RR = 0.78, 95%CI: (0.51, 1.19); P = 0.24]. Conclusions ERAT demonstrates unique advantages in pediatric acute appendicitis, including alleviating symptoms, accelerating recovery, reducing hospitalization duration and costs, minimizing complications, preserving appendiceal function, and optimizing healthcare resource utilization. Nevertheless, postoperative recurrence remains a concern, necessitating further validation through multicenter, large-scale randomized controlled trials. Study registration PROSPERO CRD420251020742, date of registration: March 27th, 2025.

Clinical efficacy and safety of endoscopic retrograde appendicitis treatment for acute appendicitis in children: a systematic review and meta-analysis

期刊论文
出版模式：

开放获取
发表日期：

2025年11月5日

查看全文

Shen Li,
Tian Geng,
Zhongyue Li

摘要

Objectives

To evaluate the clinical efficacy of endoscopic retrograde appendicitis therapy (ERAT) in the management of acute appendicitis in pediatric patients.

Methods

A comprehensive search was conducted across seven electronic databases. Methodological quality of included studies was assessed using the Cochrane risk of bias tool. Statistical analyses were performed using RevMan 5.3 and Stata 13 software.

Results

Ten studies involving 1,372 pediatric patients were included (ERAT group: 660; control group: 712). Compared to the control group, the ERAT group demonstrated significant advantages in multiple outcomes: shorter operative time [WMD = − 9.98, 95%CI: (-17.47, − 2.49); P = 0.009], higher fecalith detection rate [RR = 1.81, 95%CI: (1.43, 2.30); P < 0.00001], shorter postoperative feeding time [SMD = − 3.21, 95%CI: (− 4.04, − 2.38); P < 0.00001], lower postoperative white blood cell count [WMD = − 1.45, 95%CI: (− 1.93, − 0.96); P < 0.00001], faster normalization of white blood cell levels [WMD = − 1.62, 95%CI: (− 2.03, − 1.20); P < 0.00001], quicker resolution of fever [WMD = − 1.15, 95%CI: (− 1.48, − 0.81); P < 0.00001], shorter duration of abdominal pain relief [SMD = − 1.18, 95%CI: (− 1.59, − 0.77); P < 0.00001], reduced bed rest time [WMD = − 1.39, 95%CI: (− 1.61, − 1.18); P < 0.00001], fewer complications [RR = 0.27, 95%CI: (0.18, 0.39); P < 0.00001], higher initial treatment success rate [RR = 1.11, 95%CI: (1.06, 1.16); P < 0.0001], shorter hospital stay [WMD = − 2.21, 95%CI: (− 2.69, − 1.73); P < 0.00001], and lower hospitalization costs [SMD = − 2.84, 95%CI: (− 3.47, − 2.20); P < 0.00001]. However, no statistically significant difference was observed in recurrence rates between groups [RR = 0.78, 95%CI: (0.51, 1.19); P = 0.24].

Conclusions

ERAT demonstrates unique advantages in pediatric acute appendicitis, including alleviating symptoms, accelerating recovery, reducing hospitalization duration and costs, minimizing complications, preserving appendiceal function, and optimizing healthcare resource utilization. Nevertheless, postoperative recurrence remains a concern, necessitating further validation through multicenter, large-scale randomized controlled trials.

Study registration

PROSPERO CRD420251020742, date of registration: March 27th, 2025.