The endoscopic retrograde appendicitis therapy for acute appendicitis in children: a systematic review and meta-analysis

Background: Acute appendicitis (AA) is one of the most common abdominal emergencies in children. There has been an increasing interest in endoscopic retrograde appendicitis treatment (ERAT) in the past twenty years. We performed a meta-analysis of ERAT for AA in children through a survey and an extensive literature search that summarized the clinical features and therapeutic efficacy of ERAT. Methods: : A systematic review and meta-analysis of retrospective studies published in PUBMED, MEDLINE, Cochrane, China National Knowledge Infrastructure (CNKI), WanFang and VIP Database. The search has a limit on date from Jan 1, 2012 to Jun 31, 2022, with the last search done on Oct 31, 2022. No publication restrictions or study design filters were applied. The registration number in PROSPERO was CRD42022377739. Results: : Seven retrospective cohort studies with 423 patients were enrolled in our study. In our study, almost 57.6% (95% confidence interval (CI) 52.8%-62.4%) of children who underwent ERAT were male, the pooled rate of successful intubation was 99.5%(95%CI 98.2%-100.0%), the average time of an ERAT is approximately 49 minutes(95% CI 48.179,49.833), and efficiency of ERAT for acute appendicitis was 99.0% (95% CI 96.5%-100.0%), while, the pooled rate of recurrence was 4.2% (95% CI 2.2%-6.7%), the mean time of hospital stays was 4.319 (95% CI 4.254-4.385) days probably, and occurrence of postoperative complication was about 3.9% (95% CI 2.0%-6.2%). Conclusions: : Our results testify the relevant morbidity, clinical characteristics and prognosis in the ERAT, in spite of an enormous heterogeneity among few primary studies. ERAT has high efficiency and low recurrence rate in children with acute uncomplicated appendicitis, and preserves the physiological function of the appendix and avoids sizeabledamage, so it can be a safe and effective treatment for appendicitis in children.