Direct-visualization endoscopic retrograde appendicitis therapy for chronic appendicitis with diarrhea: clinical features and outcomes

Background and aims Chronic appendicitis complicated with diarrhea presents diagnostic and therapeutic challenges due to its atypical and prolonged symptoms, often mimicking functional gastrointestinal disorders. This study aimed to evaluate the clinical characteristics and therapeutic efficacy of Direct-visualization Endoscopic Retrograde Appendicitis Therapy (D-ERAT) in these patients. Methods We retrospectively analyzed 55 patients with chronic appendicitis and diarrhea who underwent D-ERAT under direct endoscopic visualization. Baseline demographic, clinical, and laboratory data, imaging findings, intraoperative endoscopic observations, and postoperative recovery indicators were collected. Diarrhea frequency, stool consistency, inflammatory markers, postoperative complications, and quality of life were assessed. Patients were followed up at 1, 3, and 6 months postoperatively. Results Preoperatively, patients experienced a mean of 7.5 ± 2.5 diarrhea episodes per day, with Bristol stool types 5–7. Abdominal CT identified appendiceal abnormalities in all patients, while ultrasound detected 69.1%. Endoscopic findings revealed intraluminal fecaliths in 91.5% and mucosal fibrosis in 87.27%. The patency of the appendiceal lumen was well restored in all cases after the operation. Postoperatively, diarrhea frequency decreased to 1.5 ± 0.4/day, and stool consistency normalized to Bristol types 3–4. Inflammatory markers, including WBC, neutrophil percentage, and CRP, significantly improved. At 6 months, 85.5% of patients remained largely asymptomatic, indicating stable medium-term efficacy. No major adverse events occurred. Conclusions D-ERAT is a safe and effective minimally invasive therapy for chronic appendicitis with diarrhea, offering rapid symptom relief, preserved appendiceal function, and shorter hospitalization.