Endoscopic Retrograde Appendicitis Therapy Versus Laparoscopic Appendectomy for Acute Appendicitis: A 10-Year Single-Center Retrospective Cohort Study

INTRODUCTION: Endoscopic retrograde appendicitis therapy (ERAT) is a minimally invasive, organ-preserving treatment for acute appendicitis (AA), but comparative evidence with laparoscopic appendectomy (LA) remains limited.​. METHODS: We retrospectively analyzed 450 patients with AA who underwent ERAT or LA between January 2016 and December 2025. A 1:1 propensity score-matched cohort was established. The primary endpoint was 1-year treatment success. Secondary endpoints included perioperative recovery, healthcare utilization, clinically relevant complications, recurrence, and salvage treatment.​. RESULTS: After matching, 122 patients were included in each group. One-year treatment success was lower after ERAT than after LA (104/122 [85.2%] vs 120/122 [98.4%]; P < 0.001). ERAT was associated with shorter operative/procedure time (48.0 vs 74.0 min), shorter postoperative fasting (1.0 vs 3.0 days), lower analgesic use (2.5% vs 64.8%), and lower hospitalization costs (12,306 vs 15,746 CNY; all P < 0.001). Clinically relevant complications occurred in 4.9% and 13.9% of patients, respectively (P = 0.027). During follow-up, recurrence occurred in 16 ERAT-treated patients and in no LA-treated patients (13.1% vs 0%). Most recurrences occurred within 6 months, and all recurrent cases achieved clinical resolution after salvage treatment.​. CONCLUSIONS: ERAT had a lower 1-year treatment success rate than LA but was associated with faster recovery and lower hospitalization costs. Recurrences occurred mainly within 6 months and were successfully managed with salvage treatment. These findings highlight the trade-off between short-term recovery and recurrence risk. Prospective multicenter randomized trials are needed to clarify the clinical role and patient-selection criteria for ERAT.