Endoscopic direct-vision therapy vs. antibiotics for acute uncomplicated appendicitis: a retrospective cohort study

Int J Colorectal Dis. 2026 Apr 29;41(1):90. doi: 10.1007/s00384-026-05136-4.

Abstract

Background: Endoscopic direct-vision appendicitis therapy (EDAT) is an emerging ultra-minimally invasive technique for acute uncomplicated appendicitis (AUA). Its comparative effectiveness against antibiotic therapy remains unclear.

Purpose: To compare short-term outcomes and recurrence rates of EDAT versus antibiotic therapy in AUA.

Methods: This retrospective cohort study included 92 AUA patients (41 EDAT, 51 antibiotics). Outcomes included symptom relief, hospital stay, inflammatory markers, treatment success, and recurrence. Subgroup analyses were performed based on fecalith presence and baseline inflammation severity.

Results: Baseline characteristics were comparable between groups (all P > 0.05), except for a significantly higher prevalence of fecaliths in the EDAT group (43.9% vs. 21.6%, P = 0.022). EDAT was associated with significantly faster abdominal pain relief [median 12.0 (IQR 12.0-24.0) h vs. 24.0 (12.0-36.0) h, P = 0.008], shorter hospital stay [3.0 (2.0-3.5) days vs. 4.0 (3.0-5.0) days, P < 0.001], and lower postoperative inflammatory markers (WBC =6.83 ± 1.39 vs. 8.53 ± 1.87 × 109/L, P < 0.001; CRP =7.89 ± 2.98 vs. 21.16 ± 12.21 mg/L, P < 0.001). Initial treatment success was 100% in both groups (EDAT = 41/41, antibiotics = 51/51; P = 1.000). At a mean follow-up of 7.88 ± 3.52 months (EDAT) and 14.92 ± 2.61 months (antibiotics), recurrence rates were 7.3% (3/41) vs. 27.5% (14/51), respectively (P = 0.014). Subgroup analyses confirmed that EDAT's advantages were consistent across patients with and without fecaliths, as well as across different levels of baseline inflammation severity.

Conclusion: In selected patients with AUA, EDAT offers faster symptom resolution, better early inflammatory control, and significantly lower recurrence rates compared with antibiotic therapy. The presence of fecaliths and elevated baseline CRP predicts a higher risk of antibiotic failure, suggesting that EDAT may be particularly valuable in these subgroups. Further prospective studies are warranted to clarify the role of EDAT relative to surgical appendectomy.

Keywords: Anti-bacterial agents; Appendicitis; Endoscopic direct-vision appendicitis therapy; Fecalith; Recurrence.

Publication types

  • Comparative Study

MeSH terms

  • Acute Disease
  • Adult
  • Anti-Bacterial Agents* / therapeutic use
  • Appendicitis* / complications
  • Appendicitis* / drug therapy
  • Appendicitis* / surgery
  • Endoscopy*
  • Female
  • Humans
  • Length of Stay
  • Male
  • Recurrence
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents