Digital cholangioscope-assisted endoscopic direct-vision appendicitis therapy versus laparoscopic appendectomy for chronic appendicitis: a multicenter retrospective cohort study.

Abstract

<h4>Background</h4>Laparoscopic appendectomy (LA) is the conventional treatment for chronic appendicitis. Endoscopic direct-vision appendicitis therapy (EDAT) has emerged as a minimally invasive, organ-preserving alternative.<h4>Objectives</h4>To compare the efficacy and safety of EDAT versus LA in chronic appendicitis.<h4>Design</h4>Multicenter retrospective cohort study with propensity score matching (PSM).<h4>Methods</h4>This multicenter retrospective cohort study was conducted in China between January 2019 and February 2024. PSM was performed to minimize selection bias. A total of 186 patients with chronic appendicitis were included, including 63 who received EDAT and 123 who underwent LA. The primary outcome was the clinical success rate. The secondary outcomes included the technical success rate, duration of hospitalization, adverse event rate, and recurrence rate.<h4>Results</h4>Compared with LA, EDAT showed comparable clinical success (95.2% vs 100%, <i>p</i> = 0.068) and technical success rates (96.8% vs 98.4%, <i>p</i> = 0.877). EDAT reduced the duration of hospitalization (median 2 vs 3 days, <i>p</i> < 0.001) and short- and long-term overall adverse event rates (6.4% vs 45.5% and 7.9% vs 21.1%, respectively; <i>p</i> < 0.001, <i>p</i> = 0.022). At 6, 24, and 48 h postoperatively, the EDAT group had a greater proportion of patients with no pain or mild pain than the LA group did (68.3% vs 40.7% and 90.5% vs 66.7% and 98.4% vs 74.8%, respectively; all <i>p</i> < 0.001). After the 1-year follow-up, the calculated recurrence rate did not differ between the groups (4.8% vs 0%, <i>p</i> = 0.068).<h4>Conclusion</h4>Compared with LA, EDAT is a safe, effective, organ-preserving alternative technique for chronic appendicitis, offering a shorter recovery time, reduced adverse event rates, and a low recurrence rate observed during follow-up.